Self-efficacy beliefs and fear of childbirth in nulliparous women

Is fear of childbirth related to the woman's preferred location for giving birth? A Dutch low-risk cohort study

BACKGROUND

In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference.

METHODS

In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).

RESULTS

At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W-DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition.

CONCLUSIONS

Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.

Psychometric properties of the German version of the pregnancy-related anxiety questionnaire-revised 2 (PRAQ-R2) in the third trimester of pregnancy

Background

Pregnancy-related anxiety (PrA) has been identified as a construct distinct from general stress and anxiety with a negative impact on birth and child outcomes. Validated instruments with good psychometric properties to assess pregnancy-related anxiety in German-speaking expectant mothers are still lacking. The Pregnancy-Related Anxiety Questionnaire revised for its use independent of parity (PRAQ-R2) assesses fear of giving birth (FoGB), worries of bearing a physically or mentally handicapped child (WaHC) and concerns about own appearance (CoA). The aim of this study was to investigate the psychometric properties of the PRAQ-R2 in a German sample of pregnant women in their third pregnancy trimester.

Methods

The PRAQ-R2 and several questionnaires measuring different forms of anxiety as well as depressive symptoms and perceived general self-efficacy were administered cross-sectionally in a sample of nulliparous and parous women (N = 360) in the third trimester of pregnancy.

Results

Reliability was satisfactory to excellent for the PRAQ-R2 total scale (Cronbach’s α = .85) and the subscales (α = .77 to .90). Confirmatory and exploratory factor analysis confirmed the three-factorial structure of the instrument. The three factors together explained 68% of variance. Construct validity was confirmed by positive low- to moderate-sized correlations of the PRAQ-R2 total score and the subscales with measurements of anxiety and depression and by negative low correlations with general self-efficacy.

Conclusions

The German version of the PRAQ-R2 is a valid and feasible measurement for pregnancy-related anxiety for research and clinical practice.

Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues

PURPOSE OF REVIEW

This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions.

RECENT FINDINGS

Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.

Childbirth Fear and Associated Factors in a Sample of Pregnant Iranian Women

Objectives

Fear of childbirth is common during pregnancy and may contribute to several adverse outcomes. We aimed to investigate childbirth fear and associated factors in a sample of pregnant Iranian women.

Methods

This cross-sectional study was conducted on 525 pregnant women in Sabzevar, Iran from December 2016 to March 2017. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) was used to investigate fear of childbirth.

Results

The mean W-DEQ score was 67.6±23.5. Of 525 women, 19.6% and 6.1% experienced moderate (mean W-DEQ score ≥ 85) and severe (mean W-DEQ score ≥ 100) fear of childbirth, respectively. W-DEQ scores were not different in the categories of gestational age, parity, maternal age, educational level, body mass index, and employment status (p > 0.050). The mean score of childbirth fear was significantly higher in multiparas who preferred cesarean in comparison to those who preferred vaginal delivery (p < 0.032). The mean score of childbirth fear was significantly higher in nulliparas with a lower family income compared to those with a higher family income (p < 0.011). In nulliparas, predictors of moderate and severe childbirth fear were women's description of their present pregnancy (odds ratio (OR) = 2.600; 95% confidence interval (CI): 1.323-5.112), and receiving a low level of emotional support from their husband (OR = 4.450; 95% CI: 1.349-14.674), respectively. In multiparas, predictors of childbirth fear were unwanted pregnancy (OR = 2.930; 95% CI: 1.549-3.541), experiencing moderate to severe dyspareunia in the first intercourse (OR = 2.829; 95% CI: 1.479-5.414), having a low level of physical activity (OR = 1.942; 95% CI: 1.014-3.716), and perceived a low level of health (OR = 3.415; 95% CI: 1.172-9.950).

Conclusions

We observed a relatively high prevalence of childbirth fear in pregnant women in Iran. Interventions should be implemented in high-risk women considering psychological variables.

'It definitely made a difference': A grounded theory study of yoga for pregnancy and women's self-efficacy for labour

OBJECTIVE

To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth.

DESIGN

A longitudinal grounded theory study.

METHODS

Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework.

SETTING

Three yoga for pregnancy teachers' classes in England.

PARTICIPANTS

Twenty two women attending yoga for pregnancy classes.

FINDINGS

Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.

Childbirth fear and related factors among pregnant and postpartum women in Malawi

BACKGROUND

Childbirth fear is a health concern in women living in high-income countries; however, little is known about childbirth fear among women living in low-income countries like Malawi. In this study, we explored childbirth fear and associated factors among pregnant and postpartum women in Malawi.

METHODS

A cross-sectional study of 152 pregnant and 153 postpartum women was conducted at a district hospital in Malawi. Participants were assessed for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Demographic and obstetric variables were collected using a structured questionnaire. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure social support. Using a multinomial logistic regression, factors related to childbirth fears were examined, namely demographic and obstetric characteristics, and social support.

RESULTS

The mean age of participants was 26 (standard deviation: 6.4) years. During pregnancy, 39% women reported a low level of fear, 41% reported moderate fear, and 20% reported high fear; while after birth, 49, 41, and 10% women reported low, moderate, and high fear, respectively. Pregnant women who were illiterate (odds ratio (OR): 5.0, p < 0.01) or unemployed (OR: 12.6, p < 0.01) were more likely to report moderate and high fear. Postpartum mothers who were illiterate (OR: 4.2, p < 0.01) or unemployed (OR: 11.8, p < 0.01) were more likely to have moderate and high fear. Furthermore, postpartum women who sustained perineal tears had significantly higher odds of experiencing moderate (OR: 5.3, p < 0.01) or high (OR: 19.9, p < 0.01) fear than their counterparts.

CONCLUSIONS

Childbirth fear is common in Malawi, and pregnant women are more likely to experience high levels of fear than postpartum women. This study highlighted the connection between childbirth fear with mother's education, employment, and perineal tears during delivery. Identifying and developing interventions for women with these associated characteristics is of clinical importance for the reduction of childbirth fear before and after childbirth in Malawi.

Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study

BACKGROUND

Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women's views about counselling for childbirth fear.

AIM

To explore women's experiences of midwife-led counselling for childbirth fear.

METHOD

A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth.

FINDINGS

The overarching theme 'Midwife-led counselling brought positive feelings and improved confidence in birth' was identified. This consisted of four themes describing 'the importance of the midwife' and 'a mutual and strengthening dialogue' during pregnancy. 'Coping strategies and support enabled a positive birth' represent women's experiences during birth and 'being prepared for a future birth' were the women's thoughts of a future birth.

CONCLUSIONS

In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.

Factors associated with Chinese nulliparous women's choices of mode of delivery: A longitudinal study

BACKGROUND

Caesarean section rates have risen beyond the WHO recommended level in many countries worldwide. An emerging epidemic in caesareans has appeared in China over the past two decades, mainly driven by non-medical factors. China's one-child policy was previously seen as a potential factor for contributing to women's high caesarean section rates. The Chinese government has officially announced a two-child policy in recent years, causing numerous families to reshape their fertility intentions and birth preferences. There have been few studies focusing on women's expected and actual delivery mode and the associated factors affecting their choices of mode of delivery.

OBJECTIVE

To investigate nulliparous women's expected and actual mode of delivery, and the related factors associated with delivery mode in the context of China's two-child policy.

DESIGN, SETTINGS, AND PARTICIPANTS

This longitudinal study approached 1368 pregnant women who attended the antenatal clinic regularly at a tertiary specialized women's hospital in Shanghai, China. Among the 1368 women, 1211 agreed to participate and were investigated at admission of this study.

METHODS

Data were collected via questionnaires using Birth Attitude Questionnaire (BAQ), Subjective Norm Questionnaire (SNQ), and Childbirth Self-Efficacy Scale (CSES). Descriptive statistics and logistic regression analyses were used.

RESULTS

Of 1211 participants, the number of women expecting a vaginal delivery at three pregnancy stages accounted for 74%, 78%, and 83%, respectively. Finally 48% (520/1084) ended up having a caesarean delivery. Caesarean section for lack of medical indications accounted for 57% (297/520). Among women who met the requirements of two-child policy, 39% planned to have a second child. In logistic regression analyses, participants with stronger expectations of caesarean deliveries during late pregnancy (aOR, 35.18; 95% CI, 12.66-97.74), having higher scores of birth attitude toward CS (aOR, 1.13; 95% CI, 1.06-1.20), and with lower scores of intrapartum childbirth self-efficacy (aOR, 0.85; 95% CI, 0.77-0.92) had significantly higher odds of having an actual caesarean delivery.

CONCLUSIONS

During the initial period of China's two-child policy, the majority of women value vaginal delivery whereas high caesarean section rate still becomes a great concern in current China. Individual preferences, birth attitude, and childbirth self-efficacy are altogether associated with women's different choices of mode of delivery.

A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth

BACKGROUND

Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB.

METHODS

Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies.

RESULTS

Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours).

CONCLUSIONS

Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.

Correlates and Predictors of New Mothers' Responses to Postpartum Thoughts of Accidental and Intentional Harm and Obsessive Compulsive Symptoms

BACKGROUND

Unwanted, intrusive thoughts of infant-related harm are a normal, albeit distressing experience for most new mothers. The occurrence of these thoughts can represent a risk factor for the development of obsessive compulsive disorder (OCD). As the early postpartum period represents a time of increased risk for OCD development, the transition to parenthood provides a unique opportunity to better understand OCD development.

AIMS

The purpose of this study was to assess components of cognitive behavioural conceptualizations of postpartum OCD in relation to new mothers' thoughts of infant-related harm.

METHOD

English-speaking pregnant women (n = 100) participated. Questionnaires were completed at approximately 36 weeks of gestation, and at 4 and 12 weeks postpartum. An interview to assess postpartum harm thoughts was administered at 4 and 12 weeks postpartum. Questionnaires assessed OC symptoms, OC-related beliefs, fatigue, sleep difficulties and negative mood.

RESULTS

Prenatal OC-related beliefs predicted postpartum OC symptoms, as well as harm thought characteristics and behavioural responses to harm thoughts. The severity of behavioural responses to early postpartum harm thoughts did not predict later postpartum OC symptoms, but did predict frequency and time occupation of accidental harm thoughts, and interference in parenting by intentional harm thoughts. Strong relationships between OC symptoms and harm thought characteristics, and concurrent sleep difficulties, negative mood and fatigue were also found.

CONCLUSIONS

Findings provide support for cognitive behavioural conceptualizations of postpartum OCD and emphasize the importance of maternal sleep, fatigue and negative mood in the relationship between OC-related beliefs and maternal cognitive and behavioural responses to postpartum harm thoughts.

Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education

Background

Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions.

Methods

Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390).

Results

One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased.

Conclusion

Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.

Further evidence of psychological factors underlying choice of elective cesarean delivery (ECD) by primigravidae

Objective:

Requests for elective cesarean delivery (ECD) have increased in Iran. While some sociodemographic and fear-related factors have been linked with this choice, psychological factors such as self-esteem, stress, and health beliefs are under-researched.

Methods:

A total of 342 primigravidae (mean age = 25 years) completed questionnaires covering psychological dimensions such as self-esteem, perceived stress, marital relationship quality, perceived social support, and relevant health-related beliefs.

Results:

Of the sample, 214 (62.6%) chose to undergo ECD rather than vaginal delivery (VD). This choice was associated with lower self-esteem, greater perceived stress, belief in higher susceptibility to problematic birth and barriers to an easy birth, along with lower perceived severity of ECD, fewer perceived benefits from VD, lower self-efficacy and a lower feeling of preparedness. No differences were found for marital relationship quality or perceived social support.

Conclusions:

The pattern suggests that various psychological factors such as self-esteem, self-efficacy, and perceived stress underpin the decision by primigravidae to have an ECD.

A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands

INTRODUCTION

Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain.

METHODS

Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010.

RESULTS

Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time.

DISCUSSION

It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.

Skills-based childbirth preparation reduces stress for midwives

OBJECTIVE

to explore the potential benefits of skills-based childbirth preparation on the work related stress levels of midwives.

DESIGN

a questionnaire was sent out to midwives who had clients participating in an RCT of an education package for childbirth preparation (The Pink Kit (PK) Method for Birthing Better®) delivered to parents.

SETTING

midwives were in private practice and acted as lead maternity carers to New Zealand first time mothers.

PARTICIPANTS

one hundred and four independent midwives participated.

MEASUREMENTS

a brief questionnaire using a Visual Analogue Scale to portray perceptions of work-related stress and a yes/no question about expected and/or unexpected physical complications.

FINDINGS

midwives working with clients in the intervention group experienced less work-related stress after correction for medical complications compared to the two control groups.

KEY CONCLUSIONS

working with mothers who have used a programme that increased their childbirth self-efficacy decreased the work-related stress experienced by midwives.

IMPLICATIONS FOR PRACTICE

encouraging pregnant women to develop childbirth skills merits further investigation in an effort to reduce the work-related stress experienced by midwives.

Psychological perspectives on fear of childbirth

The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.

Factors Associated with Preference for Vaginal Birth among Undergraduate Students from Southern Brazil

BACKROUND

Cesarean rates in Brazil have reached over 50 percent of all births. Multiple factors have been studied aiming to explain these rates. Mode of delivery preferences among university students may provide insights into strategies to reduce those numbers.

METHODS

A cross-sectional study was conducted enrolling students who attended Health Sciences and Human Sciences undergraduate programs in 2013. Participants answered a semi-structured questionnaire about which mode of delivery they considered the "best" (less risky and more beneficial) and the "preferred" mode (the one they would choose for themselves or their partners). Pearson chi-square was used to assess association among variables. Multiple regression analysis identified independent factors associated with the outcome measures.

RESULTS

Among the 797 students who provided complete responses (76% response rate), the mean age was 22.6 years, 61.6 percent were female, 2.6 percent had previous pregnancies, and 56.7 percent were born by cesarean. Vaginal birth was chosen as the "best" mode of delivery by 91.2 percent, and the "preferred" mode by 75.5 percent of students. Being male, born vaginally, and a Health Sciences student was associated with a preference for vaginal birth. Being a Health Sciences student and born vaginally was associated with considering vaginal birth the "best" mode of delivery.

CONCLUSIONS

Our findings indicate that the recognition of the benefits of vaginal birth do not always translate into a personal preference for vaginal birth. The student's own mode of birth was a strong predictor of their preferences for mode of delivery.

Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment

OBJECTIVE

to examine the effects of antenatal education on fear of childbirth, maternal self-efficacy, and maternal and paternal attachment.

DESIGN

quasi-experimental study, comparing an antenatal education group and a control group.

PARTICIPANTS

63 pregnant women and their husbands.

MEASUREMENTS

demographic data forms, the Wijma Delivery Expectancy/Experience Questionnaire, the Childbirth Self-Efficacy Inventory, the Maternal Attachment Inventory and the Postnatal Paternal-Infant Attachment Questionnaire were used for data collection.

FINDINGS

antenatal education was found to reduce the fear of childbirth and to increase childbirth-related maternal self-efficacy. However, antenatal education was found to have no effect on parental attachment.

KEY CONCLUSIONS

it is recommended that widespread antenatal education programmes should be provided in developing countries, and the content of the education programme about parental attachment should be increased.

IMPLICATIONS FOR PRACTICE

this study found that antenatal education has no influence on maternal and paternal attachment. As such, there is a need to increase the content of the education programme about parental attachment.

The relationship between childbirth self-efficacy and aspects of well-being, birth interventions and birth outcomes

OBJECTIVE

this study aimed to examine how women׳s childbirth self-efficacy beliefs relate to aspects of well-being during the third trimester of pregnancy and whether there was any association between childbirth self-efficacy and obstetric factors.

DESIGN

a cross-sectional design was used. The data was obtained through the distribution of a composite questionnaire and antenatal and birth records.

SETTING

data were recruited from antenatal health-care clinics in Halland, Sweden.

PARTICIPANTS

a consecutive sample of 406 pregnant women was recruited at the end of pregnancy at gestational weeks of 35-42.

MEASUREMENTS

five different measures were used; the Swedish version of Childbirth Self-Efficacy Inventory, the Wijma Delivery Expectancy/Experience Questionnaire, the Sense of Coherence Questionnaire, the Maternity Social Support Scale and finally the Profile of Mood States.

FINDINGS

results showed that childbirth self-efficacy was correlated with positive dimensions as vigour, sense of coherence and maternal support and negatively correlated with previous mental illness, negative mood states and fear of childbirth. Women who reported high childbirth self-efficacy had less epidural analgesia during childbirth, compared to women with low self-efficacy.

KEY CONCLUSIONS

this study highlights that childbirth self-efficacy is a positive dimension that interplays with other aspects and contributes to well-being during pregnancy and thereby, acts as an asset in the context of childbirth.

Factors associated with childbirth self-efficacy in Australian childbearing women

BACKGROUND

Childbirth confidence is an important marker of women's coping abilities during labour and birth. This study investigated socio-demographic, obstetric and psychological factors affecting self-efficacy in childbearing women.

METHOD

This paper presents a secondary analysis of data collected as part of the BELIEF study (Birth Emotions - Looking to Improve Expectant Fear). Women (n = 1410) were recruited during pregnancy (≤24 weeks gestation). The survey included socio-demographic details (such as age and partner support); obstetric details including parity, birth preference, and pain; and standardised psychological measures: CBSEI (Childbirth Self-efficacy Inventory), W-DEQ A (childbirth fear) and EPDS (depressive symptoms). Variables were tested against CBSEI first stage of labour sub-scales (outcome expectancy and self-efficacy expectancy) according to parity.

RESULTS

CBSEI total mean score was 443 (SD = 112.2). CBSEI, W-DEQ, EPDS scores were highly correlated. Regardless of parity, women who reported low childbirth knowledge, who preferred a caesarean section, and had high W-DEQ and EPDS scores reported lower self-efficacy. There were no differences for nulliparous or multiparous women on outcome expectancy, but multiparous women had higher self-efficacy scores (p < .001). Multiparous women whose partner was unsupportive were more likely to report low self-efficacy expectancy (p < .05). Experiencing moderate pain in pregnancy was significantly associated with low self-efficacy expectancy in both parity groups, as well as low outcome expectancy in nulliparous women only. Fear correlated strongly with low childbirth self-efficacy.

CONCLUSION

Few studies have investigated childbirth self-efficacy according to parity. Although multiparous women reported higher birth confidence significant obstetric and psychological differences were found. Addressing women's physical and emotional wellbeing and perceptions of the upcoming birth may highlight their level of self-efficacy for birth.

TRIAL REGISTRATION

Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17(th) May 2012.

High self-efficacy predicts adherence to surveillance colonoscopy in inflammatory bowel disease

BACKGROUND

Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. In this study, we assessed individual self-efficacy (SE) to estimate the probability of adherence to surveillance colonoscopies.

METHODS

Three hundred seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and with at least one third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. Medical charts were abstracted for demographic and clinical variables. The questionnaire contained a group of items assessing SE for undergoing colonoscopy.

RESULTS

We validated our 20-question SE scale and used 8 of the items that highlighted scheduling, preparation, and postprocedure recovery, to develop 2 shorter SE scales. All 3 scales were reliable with Cronbach's α ranging from 0.845 to 0.905 and correlated with chart-documented adherence to surveillance colonoscopy (P < 0.001). We then developed logistic regression models to predict adherence to surveillance colonoscopy using each scale separately along with other key variables (i.e., disease location, knowledge of correct adherence intervals, and information sources of patients consulted regarding Crohn's disease and ulcerative colitis) and demonstrated model accuracy up to 74%.

CONCLUSIONS

SE, as measured by our validated scales, correlates with chart-adherence to surveillance colonoscopy. Our adherence model, which includes SE, predicts adherence with 74% certainty. An 8-item validated clinical questionnaire can be administered to assess whether patients in this population may require further intervention for adherence.