Project
A comparison of Israeli Jewish and Arab women’s birth perceptions
Ofra Halperin, RN, PhD (Senior Lecturer)a,n, O. Sarid, PhD (Senior Lecturer)b, J. Cwikel, PhD
(Professor)b
a Emek Izrael College, Nursing Department, Israel
b Department of Social Work, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
a r t i c l e i n f o
Article history:
Received 10 April 2013
Received in revised form
6 November 2013
Accepted 10 November 2013
Keywords:
Childbirth experience
Trauma
Transcultural nursing
a b s t r a c t
Background: birth is a normal physiological process, but can also be experienced as a traumatic event.
Israeli Jewish and Arab women share Israeli residency, citizenship, and universal access to the Israeli
medical system. However, language, religion, values, customs, symbols, and lifestyle differ between the
groups.
Objectives: to examine Israeli Arab and Jewish women’s perceptions of their birth experience, and to
assess the extent to which childbirth details and perceptions predict satisfaction with the birth
experience and the extent of assessing the childbirth as traumatic.
Methods: this study was conducted in two post partum units of two major public hospitals in the
northern part of Israel. The sample included 171 respondents, including 115 Jewish Israeli and 56 Arab
Israeli women who gave birth to their first (33%) or second (67%) child. Respondents described their
childbirth experiences using a self-report questionnaire 2448 hours after childbirth.
Findings: the Arab women were much less likely to attend childbirth preparation classes than the Jewish
women (5% versus 24%). Forty-three per cent of the respondents reported feeling helpless, and 68%
reported feeling lack of control during childbirth. Twenty per cent of the women rated their childbirth
experience as traumatic, a rate much lower than the rate of medical indicators of traumatic birth (39%).
The rate of self-reported traumatic birth was significantly higher among the Arab women than among
the Jewish women (32% versus 14%). A higher percentage of the Arab women reported being afraid
during labour (24.97, po .05), expressed fear for their newborn’s safety (212.44, po .001), and
reported that the level of medical intervention was excessive in their opinion, as compared to the Jewish
women (25.09, po .05; 27.33, po .01). However, both the Arab and Jewish women reported similar
numbers of medical interventions and levels of satisfaction with their medical treatment.
Conclusions: despite universal access to the Israeli health care system, Arab Israeli women use fewer
perinatal medical resources and subjectively report more birth trauma than Jewish Israeli women. Yet,
they give birth in the same hospitals with the same practitioners and report similarly high levels of
satisfaction with the medical services. Taking into account the fact that perceptions of the birth
experience differ between ethno-cultural groups will enable professionals to better tailor intervention
and support throughout childbirth in order to increase satisfaction and minimise trauma from the
experience.
& 2013 Elsevier Ltd. All rights reserved.
Introduction and literature review
Israeli Jewish and Arab women share Israeli residency, citizenship
and access to the Israeli medical system. However, language, religion,
values, customs, symbols, and lifestyle differ between the two groups
(Klug et al., 2009). Israel is not a melting-pot society, but rather more
of a mosaic made up of different population groups coexisting within
the framework of a single democratic state. As a multi-ethnic,
multicultural, multireligious, and multilingual society, Israel has a
high level of informal segregation patterns. Although groups are
not separated by official policy, a number of different sectors within
the society have chosen to lead a segregated lifestyle, maintaining
their strong cultural, religious, ideological, and/or ethnic identity
(Jabareen, 2006).
The vast majority of Arab Israelis have chosen to maintain their
distinct identity and not assimilate. The community’s separate
existence is facilitated through the use of Arabic, Israel’s second
official language; a separate school system; literature, theatre, and
mass media; and the maintenance of independent Muslim denomi-
national court, which adjudicates matters of personal status.
Although the development of inter-group relations between Israel’s
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n Correspondence to: Nursing Faculty, The Max Stern Academic College
Emek-Yezreel, P.O. Box 105, Givat Ela 36570, Israel.
E-mail address: [emailprotected] (O. Halperin).
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Arabs and Jews has been hindered by deeply rooted differences in
religion, values, and political beliefs, the future of the Israeli Arab
sector is closely tied to that of the State of Israel. Although they
coexist as two self-segregated communities, over the years
Jewish and Arab Israelis have come to accept each other, acknowl-
edging the uniqueness and aspirations of each community and
participating in a growing number of joint endeavours (Bard and
Berman, 2012).
Health indicators in Israel present a picture of poorer health
along with lower socio-economic levels in the Arab population as
compared with the Jewish population (Israel Center for Disease
Control, 2005). For example, life expectancy in 2002 was about
three years less for Arab Israelis than for their Jewish counterparts
(Central Bureau of Statistics, 2004). In 1995, a National Health
Insurance Law (NHIL) was enacted, providing health care services
for all Israeli residents (Shvarts, 1998). The aim of the law was to
provide equal health care services for all, with the expectation that
adequate use would decrease the differences in health status
between the two population groups in Israel. Arabs have a pattern
of health care utilisation that is characteristic of lower socio-
economic status (SES) groups, even after adjusting for levels of SES
(Van Doorslaer et al., 2006). This pattern includes less use of
specialist care, more use of family doctor care, and higher rates of
hospitalisation. Other low-SES groups and minorities have been
shown to have this pattern of health care utilisation (Schoen et al.,
2000; Baron et al., 2004; Roos et al., 2005; Van Doorslaer et al.,
2006), suggesting that factors associated with ethnicity beyond
SES may be associated with health care utilisation. In the years
since the founding of the State of Israel, the Israeli Arab commu-
nity sector has made great strides in almost every area of
development. For example, the median years of schooling of Arab
Israelis rose markedly over a 35-year period (19611996) from
1.2 to 10.4 years (Reiter, 2009). For example, infant death rates
per thousand live births decreased significantly during that same
35-year period (Reiter, 2008).
Research shows significant cultural differences between women
of Arab origin and women of Jewish origin in childbirth rates and
practices. The birth rate is 2.98 per 1000 among Jewish women and
3.51 per 1000 among Arab women (Israel Central Bureau of
Statistics, 2011). Significant differences between Arab and Jewish
women have been reported on participation in an antenatal course
and in post-partum follow-up visits, which were higher among
Jewish than Arab women (Klug et al., 2009). Arab women are
usually accompanied to the delivery room by female relatives,
whereas Jewish women are usually accompanied by their partners
(Klug et al., 2009). Epidural anaesthesia prevalence is higher among
Jewish women (Klug et al., 2009), though Arab women demonstrate
more pain behaviours during childbirth (Lewando-Hundt et al.,
2001; Klug et al., 2009). Several researchers have explained this
behaviour by the lack of language proficiency in Hebrew, leading to
the demonstration of pain symptoms as an effective way to attract
attention and care without the use of language (Weisenberg and
Capsi, 1989; Harrison, 1991; Sheiner et al., 1999). The expressed
wish to breast feed is found to be higher among Arab women
(Lewando-Hundt et al., 2001; Klug et al., 2009). Studies conducted
in Israel show that Arab women reported a higher rate of breast
feeding compared with Israeli Jewish women (The Ministry of
Health, the State of Israel 2002; Chertok et al., 2004).
Cultural values serve as an important framework for under-
standing an individual’s beliefs about major life events and
transitions. Birth is considered a significant life event that is
particularly affected by the cultural context (Homer et al., 2002;
Cassar, 2006). Health beliefs regarding childbirth experiences
preserve cultural values, help the pregnant woman define the
significance of childbirth, and promote her ability to cope with
the childbirth process, as well as the personal and health
consequences (Roberts, 2002; Cassar, 2006). The way a woman
in labour responds to the birthing experience is shaped and
expressed through spiritual, religious, and cultural traditions
(Callister et al., 1999; Cassar, 2006). When significant life events
(such as the birth of a child) occur, personal religiosity may
increase (Albrecht and Cornwall, 1998), possibly due to a greater
sense of wellbeing, personal happiness, and life satisfaction
(Callister et al., 1999). How a woman perceives her childbirth
experience can influence her overall feeling of satisfaction, com-
petency, and psychosocial well-being (Hardy, 2011).
For most women, the birth of a child is a key life transition, and
when well supported by family and medical staff it can be
described as a moment of satisfaction and reward (Nelson,
2003). There remain, however, a proportion of women who are
deeply distressed following birth. Reports of distress are fre-
quently linked with descriptions of complicated, negative, or
traumatic birth experiences (Waldenstrm et al., 2004; Dahlen
et al., 2010; Sarid et al., 2010). Sarid et al. (2010) found that 23% of
women defined their first birth experiences as either negative or
traumatic, and 32% of a community sample reported at least one
such birth experience. This rate decreased in second to fourth
childbirths. A first traumatic birth was a strong predictor of
reporting subsequent traumatic childbirths. Traumatic births were
associated with fears and anxieties during pregnancy, C-section, or
vacuum childbirth, as well as a lack of persons who spoke their
native language in their social networks.
Soet et al. (2003) suggested that up to 34% of women from the
United Kingdom (UK) report their birth experience as traumatic.
An Australian study showed similar results, finding that one in
three women continued to experience traumatic related symp-
toms four to six weeks after a traumatic birth (Creedy et al., 2000).
In research conducted among Israeli Jewish women, Sarid et al.
(2010) showed that stressful life events associated with the
reproductive cycle, such as fertility problems, abortions, and
traumatic birth experiences, significantly contribute to the devel-
opment of depressive and pain symptoms several years following
the negative birth experiences. Traumatic childbirth was found to
be a significant predictor of post-partum depression and a lower
rate of breast feeding the infant (Segal-Engelchin et al., 2009).
In the scientific literature, there is no consistent definition of
traumatic birth experiences and no systematic way to assess birth
trauma. The terms birth trauma and traumatic birth experience
are used synonymously. Beck and Watson (2008) define birth
trauma as actual or threatened injury or death to the mother or
her baby (p. 229). Women may also perceive their birthing
experience to be traumatic as a result of the intervention that
was implemented during the birth process, the mode of birth
(caesarean or vaginal), and the way in which women are treated
by health care professionals (Beck and Watson, 2008). Women
may have a seemingly normal birth, but feel traumatised by
believing that their infant will die, feeling violated by intimate
examinations, or perceiving hostile or negative attitudes of people
around them (Elmir et al., 2010). Experiencing trauma during
childbirth, irrespective of the development of posttraumatic stress
disorder, can have a negative impact on the mother’s psychological
functioning and post partum adjustment (Soet et al., 2003).
Women recall their birth experiences over time, and the effect
of the traumatic experience does not subside for many of them
(Sarid et al., 2010). A traumatic birth experience can have a severe
impact on women and their families. Women have reported
negative effects on their relationship with their partner, including
sexual dysfunction, disagreements, and blame for events of the
birth, as well as a negative effect on the motherinfant attachment
(Reynolds, 1997; Waldenstrm et al., 2004; Ayers et al., 2006).
Women may have either avoidant or anxious attachments with
their child (Ayers, 2004; Olde et al., 2006). In one study, nearly all
O. Halperin et al. / Midwifery 30 (2014) 853861854
women reported initial feelings of rejection towards the infant, but
this seemed to change over time (Ayers et al., 2006). Birth trauma
can also lead to distressing problems that hinder mothers’ breast
feeding attempts (Bailham and Joseph, 2003; Sarid et al., 2010).
The impact of birth trauma on mothers’ breast feeding experiences
can lead women down two strikingly different paths. One path can
propel women into persevering in breast feeding as a means of
compensating both mother and child for an earlier negative
experience, whereas the other path can lead to psychological
distress and the wish to reduce the burden associated with breast
feeding (Beck and Watson, 2008).
The serious ramifications of perceiving the birth experience as
a negative one are now being recognised in different countries. For
example, in Sweden, women who reported a very negative birth
experience of their first child had fewer subsequent children and a
larger time interval to the second infant, as compared with women
who reported positive birth experiences (Gottvall and
Waldenstrm, 2002). Beck (2004) found that the essential com-
ponents of a traumatic birth were the lack of communication and
caring by labour and delivery personnel and the provision of
unsafe care. However, perceiving birth as traumatic may lie in the
eye of the beholder (Beck, 2004). Thompson and Downe (2008)
noted that women who have an apparently normal vaginal birth
with no intervention may also perceive their birth as traumatic.
To date, to the best of our knowledge, no research on birth
trauma has been conducted with an intercultural emphasis and in
close proximity with the childbirth. This topic is especially
important to medical personnel, who might be unaware of the
impact that cultural beliefs and behaviours may have on shaping
birth experiences. Health care professionals may also respond
stereotypically to women in labour, which can add to the women’s
perceived stressful childbirth experience. The rationale for this
study was to provide a greater understanding of cultural values
and behaviours of Arab and Jewish women in labour. We believe
that this knowledge will assist in developing sensitivity to women
in labour and enhance support for women from different ethno-
cultural groups throughout their birth experiences and the transi-
tion to parenthood. The objective of this study was to compare
Israeli Arab and Jewish women’s perceptions of their birth experi-
ence, as well as the medical and psychosocial characteristics of
the birth.
Method
Research design
This cross-sectional study was conducted in two post partum
units of two major public hospitals in the northern part of Israel, a
region characterised by wide variations in ethno-cultural groups
(Israel Central Bureau of Statistics, 2011). Between August 2011
and August 2012, we approached Israeli Arab and Jewish women
2448 hours post-childbirth and invited them to participate in a
study of their childbirth experiences. The study was approved by
the Helsinki Committee of the two medical centres. We obtained
informed consent prior to completion of a self-report question-
naire. The interview was conducted in Hebrew. The Arab-speaking
population residing in northern Israel is fluent in Hebrew, which is
the language of everyday transactions and is taught together with
Arabic in schools (Rubanovsky, 2005).
Sample characteristics
All women who gave birth between August 2011 and August
2012 as either a first or second birth were included in the study
population. Inclusion criteria were being able to speak and
understand Hebrew and giving birth to a live infant of 3442
weeks gestation (Brandon et al., 2011; Boyle and Boyle, 2013).
Those who delivered in the window of 3437 weeks were
included only if they had a normal vaginal birth with no additional
complications. Questionnaires were given to 230 women at their
bedside in the maternity ward of each hospital. Of the 230 women,
complete questionnaires were obtained from 171 (74.3% response
rate). The rest did not complete the questionnaire either because
they had no time or did not feel well at the time.
Measures
A self-report questionnaire was administered to the women
2448 hours after giving birth. This questionnaire was an adapta-
tion and expansion of a questionnaire used in an earlier study
which examined Israeli women’s pregnancy and birth experiences
(Segal-Engelchin et al., 2009; Sarid et al., 2012). In order to test the
adequacy and internal validity of the modified research instru-
ment prior to the present research, a pilot test was conducted with
a small group of 35 Arab and Jewish women. Both the setting and
the way in which the questionnaire was administered were the
same as those used in the main study. On the basis of the results,
which showed adequate variable distribution, the questionnaire
was deemed valid and comprehensible. Although the reported
childbirth experiences relied on self-report questionnaires,
their reports of medical procedures were validated against their
medical files.
The questionnaire included the following questions:
(1) Immediate assessment of childbirth as traumatic, measured
using dichotomised answers (yes, no).
(2) Satisfaction with the childbirth experience, rated as a number
on a scale of 0100.
(3) Pregnancy complications, measured by asking respondents
whether there were any complications during their
pregnancy (preeclampsia, gestational diabetes, etc.) (dichot-
omised answers: yes, no).
(4) Childbirth number (0first, 1second).
(5) Duration of birth in hours.
(6) Type of birth (vaginal birth, forceps, vacuum extraction,
planned and emergency C-section). These data were also
extracted from the women’s medical records.
(7) Additional medical procedures during childbirth: episiotomy,
emergency care in the delivery room for the newborn,
medical problems to the mother or the newborn after birth
(dichotomised answers: yes, no).
(8) Negative experiences during childbirth: helplessness, lack of
control, too much medical intervention, fear during labour,
fear for the newborn’s safety, physical harm during birth,
physical harm to the infant during labour, feeling that her life
was in danger, feeling that her infant’s life was in danger
(dichotomised answers: yes, no).
(9) Extent of pain during labour (0100). The more pain the
women experienced, the higher their stress during childbirth.
Following the approach of Pirdel and Pirdel (2009), we define
labour stress as the psychological state which combines fear
and pain, as experienced by women during labour and
reported retrospectively in the post-partum period.
(10) Previous stressful life events, measured using the Traumatic
Events Questionnaire (TEQ). The TEQ assesses experiences
with nine specific types of traumatic events (e.g., accidents,
crime, adult abusive experiences) reported in the empirical
literature as having the potential to elicit PTSD symptoms
(Vrana and Lauterbach, 1994). (Dichotomised answers: yes,
no). Cronbach’s alpha was .91. This questionnaire has been
used in other studies of trauma and childbirth, both in Israel
O. Halperin et al. / Midwifery 30 (2014) 853861 855
(Lev-Wiesel et al., 2009) and in the US (Schwerdtfeger and
Shreffler, 2009).
(11) Demographic variables included ethnicity (Jewish/Arab), age,
education, marital status, religiosity, place of birth, number of
previous childbirths or pregnancies, and number of children.
Participants
Participants were 171 Israeli women who gave birth to their
first (n57, 33.3%) or second (n114, 66.7%) child. Jewish women
comprised 67.3% (n115) of the sample and Arab Muslim women
32.7% (n56). Participants’ ages ranged between 18 and 41 years
old, with a mean age of 28.95 years (SD4.81). The Jewish women
were older (M30.43, SD4.14) than the Arab women (M25.91,
SD4.68), and the age difference was statistically significant
(t(169)6.42, po .001). The great majority of the women were
married (n161, 94.15%), whereas 4.68% (n8) were single and
1.17% (n2) were divorced. Most of the Arab women (92.9%) and
nearly three-quarters of the Jewish women (73.9%) were Israeli-
born (n85, 210.16, po .01). All the Jewish women who were
not born in Israel emigrated from the former Soviet Union.
About half of the Jewish women had an academic education
(n61, 53.0%), as compared with a third of the Arab women
(n19, 33.9%) (2 .38, p4 .05). Most of the Jewish women were
employed (n104, 90.4%), as compared with over half of the Arab
women (n33, 58.9%) (223.47, p4 .05). About two-thirds of the
Jewish women were secular in their religious observance (n74,
64.3%), as compared with one-fourth of the Arab women (n14,
25.0%) (224.05, p4 .05). More than half of the Arab women
viewed themselves as traditional, as compared with a quarter of
the Jewish women (Arab n31, 55.4%; Jewish n27, 23.5%).
A similar number of Arab and Jewish women viewed themselves
as religious (Arab n11, 19.6%; Jewish n14, 12.2%) (224.05,
p4 .05). In sum, most of the women were married and were born
in Israel. The Jewish women were older, more likely to be
employed, had a higher degree of education, and were more
secular.
Statistical analyses
Data regarding demographics, pregnancy and pre-pregnancy
stress, childbirth details and stress in childbirth, the childbirth
experience and satisfaction with it, as well as childbirth recall,
were described with frequencies, means, and standard deviations.
Comparative differences between the Arab and Jewish women
were examined with the 2 test suitable for comparison of nominal
and ordinal variables and t-tests.
Findings
Pregnancy and pre-pregnancy stress
The distributions of demographic and psychological variables
before labour for the Arab and Jewish women are presented
separately in Table 1. The great majority of both the Jewish and
Arab women reported that their pregnancies had been planned
(n143, 83.6%; 2 .13, p4 .05) and that they had suffered no
complications during this period (n122, 71.3%; 21.21, p4 .05).
No significant differences were found between the Arab and
Jewish women regarding partner support during pregnancy, with
most women reporting partner support (n162, 94.7%; 2 .00,
p4 .05). Psychological problems before or during pregnancy were
not reported by the majority of women (n145, 84.8%; 2 .05,
p4 .05).
Pregnancy stress was reported according to several measures.
Most women noted that they did not experience anxiety (n164,
95.9%; 21.13, p4 .05), sleeping difficulties (n166, 97.1%; 2
2.51, p4 .05), nervousness (n166, 97.1%; 22.51, p4 .05), mood
changes (n160, 93.6%; 2 .07, p4 .05), or restlessness (n167,
97.7%; 2 .11, p4 .05) prior to or during pregnancy. That is, most
women did not experience pregnancy-related stress or major
psychological problems.
In response to a general question regarding stressful life events,
almost half of the women (n78, 45.6%) responded that they did
have stressful life events during the pregnancy, with no differences
found between the ethnic groups (2 .65, p4 .05). Women
reported experiencing an accident, assault, war, terror, life-
threatening disease, and the like.
Childbirth details and stress in childbirth
Table 2 presents the childbirth details of the participants by
ethnicity. Very few statistically significant differences were found
between the Jewish and Arab women on details regarding their
births. Eighteen per cent of the women attended a childbirth
preparation course, with significantly more Jewish women (24%)
than Arab women (5%) (29.15, po .01). Labour was induced for
about one-fifth of the women, somewhat more among the Arab
women (216.66, po .001). Forceps and vacuum extraction were
rarely used, but were more common among the Arab women
(25.09, po .05). Episiotomy was used in over one-third of the
cases, more so among the Arab than among the Jewish women
(27.33, po .01).
In comparing the Arab and Jewish women (see Table 2), we can
see more similarities than differences between the two groups. For
about two-thirds of them, it was their second labour (one-third
reported the first labour), and most were accompanied to labour
by their husbands or by several people. Almost all women gave
birth during the 37th42nd weeks of pregnancy. Childbirth lasted
up to 72 hours, with a mean of about 10 hours and no statistically
significant difference between the ethnic groups.
In about 60% of the cases, birth was vaginal, and in others it was
a planned caesarean section (about 20%) or emergency caesarean
section (about 20%). Epidural was used in about 80% of the cases.
Pain killers, such as Nitrous and Pethidine injection, were used in
almost one-fifth of the sample, more so among the Arab than the
Jewish women (27.00, po .01). Non-pharmacological methods,
such as relaxation, breathing techniques, positioning/movement,
massage, hydrotherapy, music, guided imagery, acupressure, and
aromatherapy, are comfort strategies offered by midwives and
were used by less than 10% of the women.
Maternal or neonatal medical problems were experienced in
15% of the cases, and emergency procedures were initiated for 17%
of the newborns in the delivery room, such as oxygen to stabilise
independent breathing. There were no statistically significant
differences between the Jewish and Arab women on these
outcomes.
Childbirth experience and satisfaction
The great majority of women expressed a high level of
satisfaction with the childbirth experience, such as receiving
supportive treatment (n166, 97.1%), information and guidance
(n165, 96.5%), and good post-labour treatment (n166, 97.1%).
Most women felt that they were listened to (n167, 97.7%) and
that the staff treated them properly (n169, 98.8%). In response to
a general question regarding satisfaction with the childbirth
experience using a VAS scale (0100), both the Arab and Jewish
women reported a mean of 80.17 (SD21.52), with no significant
difference found between the ethnic groups (t(169) .37). The
O. Halperin et al. / Midwifery 30 (2014) 853861856
comparison between the Arab and Jewish women on their
experience of childbirth is shown in Table 3.
As seen in the table, several statistically significant differences
are apparent between the ethnic groups with respect to their
childbirth experience. Almost three-quarters of the women
reported being afraid during labour, more so in the Arab sector
than in the Jewish sector (24.97, po .05). Furthermore, almost
half of the women expressed fears for the newborn’s safety, again
more so by the Arab women than by the Jewish women (212.44,
po .001). Almost one-fifth of the women felt that their lives were
in danger, more so among the Arab women than the Jewish
women (24.92, po .05). About 15% of the women felt that their
infant’s life was in danger (25.09, po .05). About one-fifth of the
women rated their childbirth experience as traumatic, more so
among the Arab women than among the Jewish women (27.86,
po .01).
A meaningful portion of the women reported negative experi-
ences related to childbirth. About 40% of the whole sample
reported feeling helpless, and a little over half reported feeling a
lack of control. About a third of the women reported that there
Table 1
Distribution of pregnancy and pre-pregnancy stress by ethnicity (n171).
Jewish (n115) Arab (n56) Total (n171)
n (%) n (%) n (%)
Planned pregnancy Yes 97 (84.3) 46 (82.1) 143 (83.6) 2(1) .13
Pregnancy complications No 79 (68.7) 43 (76.8) 122 (71.3) 2(1)1.21
Partner support during pregnancy Yes 109 (94.8) 53 (94.6) 162 (94.7) 2(1) .00
Prior to and during pregnancy
Psychological problems No 98 (85.2) 47 (83.9) 145 (84.8) 2(1) .05
Anxiety No 109 (94.8) 55 (98.2) 164 (95.9) 2(1)1.13
Sleeping difficulties No 110 (95.7) 56 (100.0) 166 (97.1) 2(1)2.51
Nervousness No 110 (95.7) 56 (100.0) 166 (97.1) 2(1)2.51
Mood changes No 108 (93.9) 52 (92.9) 160 (93.6) 2(1) .07
Restlessness No 112 (97.4) 55 (98.2) 167 (97.7) 2(1) .11
Stressful life events Yes 50 (43.5) 28 (50.0) 78 (45.6) 2(1) .65
Table 2
Distribution of childbirth details by ethnicity (n171).
Jewish Arab Total
n (%) n (%) n (%)
Birth First 38 (33.0) 19 (33.9) 57 (33.3) 2(1) .01
Second 77 (67.0) 37 (66.1) 114 (66.7)
Accompanied at childbirth Yes 97 (84.3) 51 (91.1) 148 (86.5) 2(1)1.46
Preparation course Attended 28 (24.3) 3 (5.4) 31 (18.1) 2(1)9.15nn
Pregnancy week 3436 6 (5.2) 3 (5.4) 9 (5.3) 2(2) .35
3739 69 (60.0) 31 (55.4) 100 (58.4)
4042 40 (34.8) 22 (39.3) 62 (36.3)
Labour induction Yes 14 (12.2) 22 (39.3) 36 (21.1) 2(1)
16.66nnn
Birth duration .5072
hours
M8.84
(SD10.78)
M12.15
(SD13.21)
M9.93
(SD11.70)
t(169)1.75
Mode of
childbirth
Vaginal birth Yes 64 (55.7) 39 (69.6) 103 (60.2) 2(1)3.08
Used forceps Yes 1 (.9) 0 (.0) 1 (.6)
Used vacuum extraction Yes 4 (3.5) 7 (12.5) 11 (6.4) 2(1)5.09n
Used episiotomy Yes 35 (30.4) 29 (51.8) 64 (37.4) 2(1)7.33nn
Caesarean section Planned 23 (20.0) 7 (12.5) 30 (17.5) 2(1) .01
Emergency 28 (24.3) 9 (16.1) 37 (21.6)
Interventions
during labour
Epidural Yes 93 (80.9) 43 (76.8) 136 (79.5) 2(1) .39
Other pain killers
(nitrous, Pethidine
injection)
Yes 14 (12.2) 16 (28.6) 30 (17.5) 2(1)7.00nn
Natural pain killers
(essential oils, reflexology)
Yes 12 (10.4) 4 (7.1) 16 (9.4) 2(1) .48
After childbirth Special infant care
(incubator heating,
respiratory assistance)
Yes 19 (16.5) 10 (17.9) 29 (17.0) 2(1) .05
Medical problems
(as indicated in the
medical records)
Yes 19 (16.5) 7 (12.5) 26 (15.2) 2(1) .47
n po .05.
nn po .01.
nnn po .001.
O. Halperin et al. / Midwifery 30 (2014) 853861 857
was too much medical intervention, more so by the Arab women
than by the Jewish women. About one-fifth of the women revealed
that they were physically hurt during labour, and some noted that
their infant was physically hurt. The average degree of pain was
assessed as 68 (out of 100). Medical indicators of traumatic birth
(i.e., use of forceps, vacuum extraction, episiotomy, emergency
caesarean section, special care for the newborn, or medical
problems of the mother or newborn after birth) were found in
39.2% of the women, with no significant differences between the
ethnic groups (2(2)1.01, p4 .5).
Discussion
The current study comparatively analysed birth experiences
and perceptions of Israeli Arab and Jewish women 2448 hours
after childbirth. The health-related behaviours of the participants
differed with respect to their ethnic background. For example, the
Arab women were less likely than the Jewish women to attend
childbirth preparation classes, which encourage women to keep
antenatal care appointments as part of their preparation for the
birth process. This finding supports those of other studies that
Israeli Arab women are less likely to receive antenatal care on a
regular basis when compared to Jewish women residing in the
north or centre of the country (Klug et al., 2009). It is suggested
that in general Arab women do not participate in childbirth
preparatory classes because in the Arab culture pregnancy a
