Table 4.

Illustrative comments on factors influencing birth and care satisfaction

Minimizing medical intervention in childbirth
Birth positions	I didn’t know that you could give birth in other positions because I thought that the woman had to be lying down and to open her legs and that the baby would be born. That was in my head. I had never heard other things. Or maybe I had heard them but I didn’t believe how true they were. But as it turns out, with my baby I had to use another technique, another position to give birth, because if not I felt I wouldn’t be able to.
Avoiding cesarean delivery	I told my husband, “I liked it. I can’t imagine being in Guatemala because there it’s not like here.” Here they asked me why I had the baby Cesarean and I requested the papers [from Guatemala] and they didn’t want to give me any information. Nothing. So they [here] said, “well let’s see how we can try [vaginal birth].”
Following a birth plan	They weren't offering me an epidural, because, in my birth plan, I had said I didn't want an epidural… they followed it as closely as they could, and that's one thing I really appreciated about the hospital, is that they respected my birth plan… at one point I was like 'well give me anything' and they were like 'well you know we're trying to go according to your birth plan'. You know they would at least talk to me about it.
Relationship with birth attendants
Multiple anonymous providers	…well I don’t know if it was normal but I felt like because I was pushing and it wasn’t coming out yet, they would go away and then when another would say, ‘oh yes, yes’ and then they would all come back. And so this was uncomfortable because they weren’t paying attention to, they weren’t giving me the support that I needed. They were thinking, “no this will take longer” or “she’s still taking longer,” and so they would go away, and then they would come back.
Uncomfortable presence of trainees	I had one [nurse] but then about 30 came all at once when I was giving birth. That was something else that I didn’t like. I thought it was just going to be the ones that were there but then the students came. I didn’t like that because everyone was watching me…
Conflicting signals	Because when the baby starts to come out and vulva is little and afterwards it starts opening and so that hurts. It starts stretching and so since the doctor was attending another patient, I wanted to get her out, I didn’t want her inside because I couldn’t stand the pain anymore. And so they had me in the bed and so when I pushed they said, “no! no push yet! The doctor’s not here” And I said, “I want to get her out! I want her out of me!” … I pushed and so one of the nurses … said, “don’t push!” And I pushed harder to get her out of me. I said, “I can’t stand it anymore. I’m gonna do it.”