"It's between life and death": Nigerian women's experience of pregnancy and childbirth.

Objectives: We sought to capture Nigerian women's experiences from pregnancy to childbirth, to understand how events impacted their psychological wellbeing and to afford women a voice in determining a more positive birth experience.Methods: Mothers (N = 12) were recruited in Lagos, Kaduna, Abuja and Osun for interviews. Interviews were analysed using reflexive thematic analysis, drawing on self-determination theory (SDT) to interpret how participants' experiences shaped their wellbeing.Results: Themes of Community, communication and perceived changes in social status, Expectations of transition to motherhood vs reality, and Managing risk and uncertainty along the journey to motherhood were identified. In keeping with SDT, all themes encompassed women's drive for autonomy, relatedness and competence during transition to motherhood. While pregnant, women considered the family and community important in meeting their need for relatedness, they also perceived them as eroding their autonomy and constraining their competence. Autonomy and competence were strengthened in seeking information on what to expect during pregnancy and birth. The women were able to derive autonomy during labour by suppressing any vocal expression of pain and alluded to the sense of competence and achievement they felt if they had laboured silently. A novel finding was that birthing was located at the cusp of life and death, and amidst this uncertainty, relatedness and competence to deliver were sought in God.Conclusion: These findings imply that greater attention to women's psychological needs could retain their autonomy, competence and relatedness during pregnancy and childbirth. Women should be encouraged to become informed about pregnancy and birth but may need guidance to reliable sources. Practitioners should be aware that women need the support of significant others during labour.