Risk factors for poor self-rated health in women at 2 months and 1 year after childbirth

A survey of worries of pregnant women: reliability and validity of the Greek version of the Cambridge Worry Scale

OBJECTIVE

to examine the psychometric properties of the Greek version of the Cambridge Worry Scale (CWS) and to assess worries during pregnancy.

SETTING

public hospital in Athens, Greece.

DESIGN

a cross sectional study.

PARTICIPANTS

one hundred and thirty two pregnant women with a gestational age between 11 and 14 weeks who were booked for antenatal screening.

METHODS

CWS was 'forward-backward' translated from English into Greek. The translated instrument was pilot-tested and administered to a sample of 132 pregnant women. Principal component analysis with promax rotation was used to test the factor structure of CWS. Measures of state-trait anxiety (STAI) and depression (CES-D) were used to assess the convergent validity of CWS. Cronbach's α was used to measure internal consistency of the FPI scales.

FINDINGS

results from exploratory factor analysis suggested the existence of four factors. Therefore, the Greek version replicated the original factor structure. Construct validity was confirmed by computing correlations between the CWS factors and conceptually similar constructions of anxiety, and depression. Internal consistency reliability was satisfactory. The major worries that pregnant women referred to were the possibility that something might be wrong with the baby, the process of giving birth, financial issues and the possibility of miscarriage.

CONCLUSION

the CWS was found to have a relatively stable factor structure and satisfactory reliability and convergent and discriminant validity. CWS may enable researchers and clinicians to apply a reliable measure that focuses on worries during pregnancy.

The effectiveness of an early parenting intervention for mothers with infants with sleep and settling concerns: a prospective non-equivalent before-after design

AIM

The study aim was to compare changes in maternal confidence, competence, depression, anxiety and settling behaviours and children's sleep and settling behaviours for mothers and infants (4-6 months of age) attending a Day Stay intervention at an early parenting centre in Western Australia and a community group.

BACKGROUND

Infant difficulties in getting to sleep and frequent night waking are concerns for parents. Techniques are available to assist parents with infants exhibiting behavioural sleep problems; however, parents often lack confidence to consistently initiate sleep interventions.

DESIGN

The study incorporated a prospective non-equivalent before-after design.

METHOD

The conceptual framework guiding this intervention emphasised the development of parental confidence and competence through connection with practitioners to promote change. Both groups provided baseline data (time 1) and four weeks postbaseline (time 2). Recruitment occurred between July 2007-July 2009.

RESULTS

The Ngala group (n = 93) and community group (n = 85) were not equivalent for infant age and maternal parity; there were more multiparous mothers in the community group, with infants on average one week older. The Ngala group, the majority of which were primiparous women, had significantly higher levels of competence and confidence four weeks following their Day Stay visit. There were no significant differences between groups at time 2 for time to settle the infant at night, infant night waking and maternal depression and anxiety scores.

CONCLUSIONS

Although both groups demonstrated an improvement in depression and anxiety scores, with decreased sleep and settling concerns, the results indicate parental inconsistency in settling approaches. Given links between inconsistent infant settling approaches and infants' difficulty with sleep self-initiation, further exploration is warranted.

RELEVANCE TO CLINICAL PRACTICE

The conceptual framework guiding the Ngala practitioners was effective in developing confidence and competence for the sample.

Maternal general health and children's cognitive development and behaviour in the early years: findings from the Millennium Cohort Study

BACKGROUND

Mothers often experience physical and psychological difficulties during the post-natal period and these may continue through the early years of raising children and have negative effects on engagement and caregiving. Pathways between maternal depression, parental engagement and caregiving and children's subsequent development have been described in longitudinal studies; yet, less is known about how other aspects of maternal health may influence children's development.

METHODS

A longitudinal analysis within the Millennium Cohort Study was conducted including 7906 families from England. Maternal general health and psychological well-being were assessed when their children were 9 months and 3 years old, socio-demographic characteristics were assessed at 9 months, and engagement and caregiving were assessed at 3 years. These were examined as predictors of children's learning and development and behaviour at age 5.

RESULTS

There are clear associations between maternal general health and children's development with regard to both learning and development and behaviour. These effects are reduced if psychological distress is taken into account; yet, maternal general health maintains importance as a predictor for children's subsequent development. There is evidence of an association via engagement and caregiving which links maternal health to children's development and evidence of the influence of underlying socio-demographic disadvantage.

CONCLUSION

General maternal health as well as psychological well-being during the early years of raising children may be influential for children's development. This study suggests the need for a broader recognition of maternal health as well as psychological well-being as a foundation for family well-being, and speaks to support for mothers in maintaining engagement and caregiving for their children during periods of ill health.

Factors independently related to a negative birth experience in first-time mothers

OBJECTIVE

To evaluate the impact of personality, socio-demographic and obstetric factors on birth experience in a cohort of healthy first-time mothers. A second aim was to compare a visual analogue scale and Wijma Delivery Experience Questionnaire B as instruments evaluating birth experience.

MATERIAL AND METHODS

In total, 541 women were prospectively followed from the end of pregnancy until 9 months postpartum. Socio-demographic, psychological and somatic data as well as personality characteristics were collected. Experience of delivery was measured with a visual analogue scale and with Wijma Delivery Experience Questionnaire B. Sixty-three variables were considered to be associated with the experience of delivery. Nineteen of these, found to be significantly associated with birth experience, were entered in a logistic regression analysis.

RESULTS

The logistic regression analysis showed that a memory of pain during birth, high usage of analgesics postpartum, long hospital stay, worry in late pregnancy and high self-rated irritation were related to a more negative birth experience, while high confidence in the midwife was related to a more positive experience. The correlation between experiences of delivery rated by Wijma Delivery Experience Questionnaire B and the visual analogue scale was 0.52 (p < 0.001).

CONCLUSION

To help women to cope with pain during and after birth could be an important factor to improve birth experience. Even though the correlation between the visual analogue scale and Wijma Delivery Experience Questionnaire B was moderate, the visual analogue scale could be used as a simple method for screening of birth experience.

The correlation between postpartum depression and health status

To investigate a purported correlation between postpartum depression and self-rated maternal general health status in a sample of mothers in Southern Brazil. As part of this process, the Personal Health Scale (PHS), a self-rated health status measure, was tested for the first time among postpartum women. Research volunteers completed the Structured Clinical Interview for DSM-IV Disorders (SCID), the 12-item General Health Questionnaire (GHQ), the PHS, the Postpartum Depression Screening Scale (PDSS), and the Edinburgh Postnatal Depression Scale (EPDS). Correlation coefficients were computed among the scores of the health status questionnaires and the postnatal depression scales. Bivariate linear regression analyses were conducted to evaluate the prediction of scores of postnatal depression scales having the scores of health status questionnaires as predictors. Significant correlations among both health status questionnaires and both postnatal screening tools attest to a significant interconnection between the expression of depressive symptoms and maternal health status in the postpartum period. The health status measures predicted the scores of postpartum depression scales. This study demonstrates that both general health questionnaires and postpartum depressive rating scales are useful tools for detecting depressive phenomena in postpartum women. The association between self-rated health measures and postpartum depression may be even more significant in the context of socioeconomic deprivation.

A survey on worries of pregnant women--testing the German version of the Cambridge worry scale

Background

Pregnancy is a transition period in a woman's life characterized by increased worries and anxiety. The Cambridge Worry Scale (CWS) was developed to assess the content and extent of maternal worries in pregnancy. It has been increasingly used in studies over recent years. However, a German version has not yet been developed and validated.

The aim of this study was (1) to assess the extent and content of worries in pregnancy on a sample of women in Germany using a translated and adapted version of the Cambridge Worry Scale, and (2) to evaluate the psychometric properties of the German version.

Methods

We conducted a cross-sectional study and enrolled 344 pregnant women in the federal state of Baden-Württemberg, Germany. Women filled out structured questionnaires that contained the CWS, the Spielberger-State-Trait-Anxiety Inventory (STAI), as well as questions on their obstetric history. Antenatal records were also analyzed.

Results

The CWS was well understood and easy to fill in. The major worries referred to the process of giving birth (CWS mean value 2.26) and the possibility that something might be wrong with the baby (1.99), followed by coping with the new baby (1.57), going to hospital (1.29) and the possibility of going into labour too early (1.28). The internal consistency of the scale (0.80) was satisfactory, and we found a four-factor structure, similar to previous studies. Tests of convergent validity showed that the German CWS represents a different construct compared with state and trait anxiety but has the desired overlap.

Conclusions

The German CWS has satisfactory psychometric properties. It represents a valuable tool for use in scientific studies and is likely to be useful also to clinicians.

Self-rated health--what does it capture at 1 year after childbirth? Investigation of a survey question employing thinkaloud interviews

AIM

This paper reports an investigation of how the survey question 'How would you summarize your state of health at present' is interpreted and what it captures when asked at 1 year after childbirth.

BACKGROUND

Self-rated health measured by a single item question is a well-established patient outcome as it predicts morbidity and the use of health services. However, there is limited understanding of what the question captures in early motherhood.

METHOD

A qualitative design combining data collection by means of a short form, concurrent and retrospective thinkaloud interviews, and a semi-structured interview, with 26 Swedish women during 2005 was employed. The text was analysed by qualitative content analysis. A theoretical framework describing four cognitive tasks usually performed when a respondent answers a survey question guided the analysis: interpretation of the question, retrieval of information, forming a judgement and giving a response.

FINDINGS

The questions of self-rated health left open for the new mothers to evaluate what was most important for her. It captured a woman's total life situation, such as family functioning and well-being, relationship with partner, combining motherhood and professional work, energy, physical symptoms and emotional problems affecting daily life, stressful life events, chronic disease with ongoing symptoms, body image, physical exercise and happiness. Neither childbirth-related events nor childbirth-related symptoms were included in the responses. Less than 'good' self-rated health represented a high burden of health problems.

CONCLUSION

Our results showed that the question on self-rated health was a measure of women's general health and well-being in their present life situation, but it did not seem to measure recovery after childbirth specifically.

Evaluation of changes in postnatal care using the "Parents' Postnatal Sense of Security" instrument and an assessment of the instrument's reliability and validity

BACKGROUND

A sense of security is important for experiences of parenthood in the early postpartum period. The objectives of this study were to evaluate two models of postnatal care using a questionnaire incorporating the Parents' Postpartum Sense of Security (PPSS) instrument and to test the validity of the PPSS instrument.

METHODS

Postal surveys were sent to 234 mothers who had experienced two different forms of postnatal care (study group and control group) and returned by 86.8%. These two groups of mothers were compared for total scores on the PPSS instrument. Demographic variables and mothers' opinions about care interventions were also compared and these variables were tested for correlations with the total PPSS score. A regression analysis was carried out to assess areas of midwifery care which might affect a sense of security. The internal consistency and concurrent validity of the instrument were tested for the total population.

RESULTS

there were no significant differences between the groups for scores on the PPSS instrument. A total of three variables predicted 26% of the variability on the PPSS scores for the study group and five variables predicted 37% of the variability in the control group. One variable was common to both: "The midwives on the postnatal ward paid attention to the mother as an individual". There were significant correlations between the total PPSS scores and scores for postpartum talks and visits to the breastfeeding clinic. There was also a significant correlation between the single question: "I felt secure during the first postpartum week" and the total PPSS score. Tests for internal consistency and concurrent validity were satisfactory.

CONCLUSION

The proposed new model of care neither improved nor impaired mothers' feelings of security the week following birth. Being seen as an individual by the midwife who provides postnatal care may be an important variable for mothers' sense of postnatal security. It is possible that postpartum talks may encourage the processing of childbirth experiences in a positive direction. Availability of breastfeeding support may also add to a sense of security postpartum. The PPSS instrument has shown acceptable reliability and validity.

Predictors of Women's Postpartum Health Status in the First 3 Months After Childbirth

PURPOSE

The purpose of this study was to examine the significant predictors of postpartum health indicated by physical health, mental health, and role performance during the first 3 months postpartum.

METHODS

This study used a correlational survey design. The study subjects were 152 mothers at 6 weeks postpartum (T1) and 131 mothers at 3 months postpartum (T2). At 6 weeks and 3 months postpartum, subjects completed a packet of instruments-measuring physical and mental health, role performance, sense of mastery, social support, and infant temperament.

RESULTS

Findings indicated that lower family income, more difficult infant temperament, and lower sense of mastery were consistently significant predictors of poorer health outcomes during the postpartum period. Having preterm infants and caring for them was related to higher levels of maternal fatigue in the morning at 6 weeks. Employment did not influence postpartum health.

CONCLUSION

The findings suggest that mother and infant's individual factors and environmental context may continue to negatively affect the mother's health outcomes during the postpartum period.

Women with non-Swedish speaking background and their children: a longitudinal study of uptake of care and maternal and child health

AIM

To study uptake of care at the antenatal and child health clinic (CHC), and maternal and child health up to 5 years after the birth, as reported by mothers with a non-Swedish speaking background (NSB).

METHODS

A sample of 300 women with a NSB, 175 originated from a poor country and 125 originated from a rich country, were compared with a reference group of 2761 women with a Swedish speaking background. Four postal questionnaires were completed: during pregnancy, and 2 months, 1 year and 5 years after the birth.

RESULTS

Mothers with a NSB from a poor country of origin did not differ from the reference group of mothers with a Swedish speaking background regarding number of clinic visits, but they had a lower attendance rate at antenatal and postnatal education classes. Depressive symptoms, parental stress and poor self-rated health were more common in these women, and they reported more psychological and behavioral problems in their 5-year olds. Women with a rich country origin did not differ from the reference group regarding maternal and child health, but had a lower uptake of all out-patient care, except parental classes after the birth.

CONCLUSION

Women originating from a poor country seem to be under great stress during pregnancy and the child's first years.