Sense of coherence and childbearing choices: A cross sectional survey

Sense of coherence as facilitated by water immersion during labour and birth: A concept analysis and synthesis

OBJECTIVE

To explore the concept of sense of coherence as facilitated by water immersion during labour and/or birth.

DESIGN

A concept analysis and synthesis. A literature search of CINAHL, Medline, PubMed, PsycINFO and Emcare was undertaken in February 2022. Results were cross-checked with Google Scholar. No timeframe was specified, and results were restricted to research papers written in English. Overall, 2768 papers were retrieved and after removal of duplicates and unrelated papers, abstracts were screened to ensure the paper met the inclusion criteria i.e. women's experiences of water immersion for labour and/or birth. This process yielded a total of 37 articles and two theses, these were used for the concept analysis. Attributes were described and an exemplar case developed after mapping and charting of the data set.

FINDINGS

Three attributes were identified; agency, holistic and complete and more than pain relief which align with the three sense of coherence components: comprehensible, meaningfulness and manageability.

KEY CONCLUSION

There is a growing evidence base regarding the use of intrapartum water immersion. The literature exploring women's experiences and views of water immersion, appears to consistently report that women experience physiological, physical and psychological benefits and that these benefits complement each other to facilitate greater self-efficacy and a more holistic experience. This combination of benefits afforded by water immersion facilitates a sense of coherence and subsequently, increases the likelihood of the woman experiencing labour and birth as both positive and satisfying.

IMPLICATIONS FOR PRACTICE

A greater understanding of women's experiences of water immersion will provide rationale and reason for making the option a real choice while revealing the positive impacts that it can have on all outcomes beyond just the physical.

'How is our job affecting us?' Neonatal Intensive Care Unit healthcare providers and their pregnancy: A descriptive qualitative study

AIM

The aim of this study was to understand the Neonatal Intensive Care Unit (NICU) healthcare providers' (HCPs) experiences and needs during their own past, present and desired pregnancies. It has been reported that HCPs' personal and professional lives are mutually interconnected. Given the NICU HCPs' knowledge of the risks and potential adverse outcomes of newborns admitted to the NICU, their pregnancy experience may be more challenging than that of the general population. However, to date, these aspects are still little studied.

DESIGN

A qualitative descriptive study design was adopted.

METHODS

Semi-structured interviews were conducted between January and April 2021 in a single third-level NICU in northeastern Italy. Transcripts were analysed using inductive content analysis. Findings are reported according to the COREQ guidelines.

RESULTS

Nineteen HCPs participated in this study. Participants included 12 nurses, 6 medical doctors, and 1 paediatric physical therapist. All participants reported that their professional knowledge and experience influenced their pregnancy-related experiences, emotions and behaviours. Some participants employed adaptive coping strategies, while others were likely to experience post-traumatic stress reactions. The narratives of the men and women were similar. Three themes were identified: 'Feeling different'; 'Influence of work experience on decision-making'; 'Coping with difficulties'.

CONCLUSION

To reduce the potential impact of NICU HCPs' work experience on pregnancy, family functioning and infant health, management of parental emotions should be considered for this population.

IMPACT

Hospital managers could prevent the potential distress of vulnerable NICU healthcare workers during pregnancy by tailoring interventions aimed at supporting them in becoming aware and making sense of their work experiences or sensitizing individual psychological support. Moreover, university students should be offered self-help strategies to face potential dual role conflicts in their future careers.

PATIENT AND PUBLIC INVOLVEMENT

No patient or public contribution.

Sense of Coherence Mediates the Links between Job Status Prior to Birth and Postpartum Depression: A Structured Equation Modeling Approach

Postpartum depression (PPD) has detrimental effects on the health of the mother, child and family. Socio-demographic variables can influence PPD. Sense of coherence (SOC) is a personal resource that mitigates the experience of stressful events. We hypothesized that SOC would have a protective effect against PPD over time. The aim was to investigate the effects of socio-demographic factors and SOC on PPD at birth (T1) and nine months postpartum (T2). A longitudinal study of primiparous women (n = 114; age range 18-47 years) measured PPD, SOC and socio-demographics at T1 and T2. The majority were married, had no economic difficulties and were employed before birth. Results showed that PPD at T1 (15.8%) declined to 6.2% (T2). Job status was positively associated with SOC at T1. The structured equation model accounted for 27% of the variance in PPD (T2). In the first pathway, job status was linked to PPD (T2) via SOC at T1 and T2. In the second, SOC and PPD (T1) and SOC (T2) mediated the link between job status and PPD (T2). Results and clinical implications are discussed in the context of the theory of conservation of resources. An intervention for enhancing SOC is recommended for woman at risk of PPD.

Application of the salutogenic theory in the perinatal period: A systematic mixed studies review

BACKGROUND

The pregnancy process has always been medicalized with a focus on the prevention of adverse pregnancy outcomes and a lesser emphasis on enhancing women's wellbeing during the perinatal period. This trend urges healthcare professionals to consider the use of a salutogenic approach throughout the perinatal period.

OBJECTIVE

To consolidate and appraise evidence on the use of the salutogenic theory across the perinatal period.

DESIGN

A systematic mixed studies review.

METHODS

Four electronic databases (CINAHL, ScienceDirect, PsycINFO, and PubMed) were searched for English studies from each database's inception to November 2018. Thirty-four studies met the inclusion criteria and were appraised for quality by two researchers independently. A narrative synthesis was conducted to consolidate and synthesize results from mixed methodology studies.

RESULTS

Four themes emerged from the synthesis: (1) factors affecting sense of coherence (generalized resistance resources), (2) influences of sense of coherence, (3) ways to promote sense of coherence among mothers, and (4) use of salutogenic framework across perinatal healthcare. Sociodemographic background, psychological and birth-related factors, and availability of social support affect sense of coherence among parents, which are positively correlated to quality of relationship, satisfaction of perceived support, psychological wellbeing, and overall birth experience. Sense of coherence also determines mothering orientation and choice of delivery method. Ways to enhance maternal sense of coherence include ensuring continuity of care in the postpartum period, increasing parental involvement, focusing on wellness topics, and having balanced relationships between parents and healthcare providers.

CONCLUSION

Despite consolidating evidence on positive relationships of generalized resistance resources, sense of coherence, and parental outcomes during the perinatal period, the scarcity of literature highlights a need for more in-depth research on the underlying mechanisms of salutogenesis and its components as these insights may underpin future maternal health promotion efforts.

'I'm having a baby not a labour': Sense of coherence and women's attitudes towards labour and birth

OBJECTIVE

In Western countries, caesarean section rates are increasing and spontaneous vaginal birth rates are decreasing at a rapid rate. This trend has implications for childbearing women's health and calls into question the use of pathogenesis to frame maternity services. The theory and practice of salutogenesis offers a viable alternative as it emphasises health rather than illness. Sense of coherence and generalized resistant resources (GRRs) are the cornerstones of salutogenesis and sense of coherence is a predictive indicator of health. As strong sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with weak sense of coherence, the objective of this study is to examine the association between sense of coherence and women's attitude towards their birthing experiences.

DESIGN, SETTING AND PARTICIPANTS

This paper reports on the qualitative component only of a longitudinal study where 753 women planning to have their babies in an Australian tertiary maternity service, completed questionnaires in pregnancy and postnatally. Women answered one openended question during the pregnancy and one open-ended question approximately eight weeks postnatally. Data were analysed by qualitative content analysis.

FINDINGS

When the open-text responses of 119 women with strong sense of coherence and 177 women with weak sense of coherence were analysed, the categories of Language, Demeanour and Focus were identified. Women with strong sense of coherence have a positive, relaxed and baby-focused attitude. In salutogenic terms this attitude towards labour and birth can be described as increased comprehensibility, increased manageability, decreased meaningfulness in the experience of giving birth, increased internal GRRs and increased external GRRs. Women with weak sense of coherence have a more negative, worried and labour-focused attitude. In salutogenic terms this attitude towards labour and birth can be described as decreased comprehensibility, decreased manageability, increased meaningfulness in the experience of giving birth, decreased internal GRRs and decreased external GRRs.

KEY CONCLUSION

Strong sense of coherence in childbearing women is expressed through a positive, relaxed and baby-focused attitude while weak sense of coherence is expressed through negative, worried and labour-focused attitude in childbearing women towards labour and birth.

IMPLICATIONS FOR PRACTICE

As sense of coherence is a modifiable predictor of health, application of the study findings could focus on midwifery work including antenatal education that aims to decrease caesarean section rates by strengthening women's sense of coherence in pregnancy.

Look to Norway: Serving new families and infants in a multiethnic population

Despite recognition that immigrant women face significant health challenges, addressing the healthcare needs of immigrants is a source of debate in the United States. Lack of adequate healthcare for immigrants is recognized as a social justice issue, and other countries have incorporated immigrants into their healthcare services. Oslo, the fastest growing capital in Europe, is rapidly shifting to a heterogeneous society prompting organizational action and change. The New Families Program serves first-time mothers and their infants in an Oslo district serving 53% minorities from 142 countries. Anchored in salutogenic theory, the program aims to support the parent-child relationship, children's development and social adaptation, and to prevent stress-related outcomes. Formative research has informed the successful program development and implementation within the existing maternal and child healthcare service. Implications for addressing maternal and child health needs of an immigrant population are presented.

'I felt like I could do anything!' Writing the phenomenon of 'transcendent birth' through autoethnography

OBJECTIVE

To discuss the concept of 'transcendent birth', an as yet poorly articulated and under recognised psychosocial wellness phenomenon of childbirth.

DESIGN

an auto-ethnographical examination of the primary authors' journaled experiences as a student midwife and childbearing woman.

SETTING

three maternity care units in South Eastern Australia as well as the home of the primary author.

FINDINGS

The phenomenon of transcendent birth is linked with physiologic birth. Maternity care can hinder or facilitate physiologic birth, and therefore transcendent birth.

KEY CONCLUSIONS

Transcendent birth is more likely in maternity care models which value the childbearing woman and physiologic birth.

IMPLICATIONS FOR PRACTICE

Women's access to transcendent birth is demarcated by women's position in society, cultural knowledge of transcendent birth and the valuing of transcendent birth as a maternity care outcome.

Antenatal depressive symptoms during late pregnancy among women in a north-eastern province of Thailand: Prevalence and associated factors

BACKGROUND

Globally, depression is prevalent during pregnancy and several factors have been associated with antenatal depressive symptoms (ADS). However, ADS have rarely been investigated in Thailand. This study aimed at exploring the prevalence of ADS and factors associated with these symptoms among Thai women in late pregnancy.

METHODS

A cross-sectional study including 449 women in late pregnancy was carried out. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms with a score of 10 points or higher. Socio-demographic characteristics and psychosocial risks were measured in association with ADS. Percentage and 95% confidence interval (CI) were used to assess the prevalence of ADS. Odds ratio (OR) and 95%CI were used to determine ADS-related risk factors among women.

RESULTS

The prevalence of ADS was 46.8% (95%CI 42.3-51.4). Pregnant women aged less than 20 years (OR 2.58, 95%CI 1.14-5.84) and those not having enough money (OR 2.71, 95%CI 1.22-6.05) had an increased risk of ADS. Psychosocial risks related to ADS for women were low psychological well-being (OR 3.12, 95%CI 1.75-5.58), low self-esteem (OR 2.08, 95%CI 1.24-3.49), and low sense of coherence (OR 1.82, 95%CI 1.12-2.95).

CONCLUSIONS

The prevalence of ADS among Thai women in their late pregnancy is high. Socio-demographic characteristics and psychosocial factors are independently associated with ADS. Healthcare providers in Thailand should consider EPDS as a standardised screening tool for ADS and use it at antenatal care clinics. Implementing programs focusing on both pregnant women and their family might increase the prevention of perinatal depression.

The perceptions and experiences of women who achieved and did not achieve a waterbirth

BACKGROUND

There is a gap in knowledge and understanding relating to the experiences of women exposed to the opportunity of waterbirth. Our aim was to explore the perceptions and experiences of women who achieved or did not achieve their planned waterbirth.

METHODS

An exploratory design using critical incident techniques was conducted between December 2015 and July 2016, in the birth centre of the tertiary public maternity hospital in Western Australia. Women were telephoned 6 weeks post birth. Demographic data included: age; education; parity; and previous birth mode. Women were also asked the following: what made you choose to plan a waterbirth?; what do you think contributed to you having (or not having) a waterbirth?; and which three words would you use to describe your birth experience? Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis was undertaken to extract common themes from the interviews.

RESULTS

A total of 31% (93 of 296) of women achieved a waterbirth and 69% (203 of 296) did not. Multiparous women were more likely to achieve a waterbirth (57% vs 32%; p < 0.001). Women who achieved a waterbirth were less likely to have planned a waterbirth for pain relief (38% vs 52%; p = 0.24). The primary reasons women gave for planning a waterbirth were: pain relief; they liked the idea; it was associated with a natural birth; it provided a relaxing environment; and it was recommended. Two fifths (40%) of women who achieved a waterbirth suggested support was the primary reason they achieved their waterbirth, with the midwife named as the primary support person by 34 of 37 women. Most (66%) women who did not achieve a waterbirth perceived this was because they experienced an obstetric complication. The words women used to describe their birth were coded as: affirming; distressing; enduring; natural; quick; empowering; and long.

CONCLUSIONS

Immersion in water for birth facilitates a shift of focus from high risk obstetric-led care to low risk midwifery-led care. It also facilitates evidence based, respectful midwifery care which in turn optimises the potential for women to view their birthing experience through a positive lens.

The Psychological Experience of Physiological Childbirth: A Protocol for a Systematic Review of Qualitative Studies

PURPOSE: The purpose of this systematic review of the literature is to look at the current evidence of the psychological experience of physiological childbirth.

BACKGROUND: Childbirth is a dynamic process in which the fetal and maternal physiology interacts with the woman’s psychosocial context, yet this process is predominantly evaluated using objective, physical measures. Simultaneously, childbirth is also a profound psychological experience with a deep impact in women that is physical, psychological, and social. The description of the psychological processes and experiences that happen during physiological childbirth will likely improve the care women receive during childbirth as health care professionals and carers will have a greater understanding of the process.

METHODS/DESIGN: The electronic databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, PsycARTICLES, SocINDEX, and Psychology and Behavioral Sciences Collection will be searched using the EBSCOhost platform to identify studies that meet the inclusion criteria. No language or publication date constraints will be applied. Articles that pass the 3-stage screening process will then be assessed for risk of bias and have their reference lists hand searched.

DISCUSSION: By synthesizing the results of the studies, this systematic review will help illuminate gaps in the literature, direct future research, and inform policymakers.

Sense of coherence in pregnant and new mothers - A longitudinal study of a national cohort of Swedish speaking women

BACKGROUND

Previous research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored.

AIM

The aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress.

METHODS

A longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999-2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth.

RESULTS

SOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year.

CONCLUSION

Sense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.

Sense of coherence and women׳s birthing outcomes: A longitudinal survey

BACKGROUND

in Western countries, caesarean section rates are increasing at an alarming rate. This trend has implications for women׳s health and calls into question the use of pathogenesis to frame maternity services. The theory of salutogenesis offers an alternative as it focuses on health rather than illness. Sense of coherence (SOC), the cornerstone of salutogenesis, is a predictive indicator of health. This study aimed to explore associations between pregnant women׳s SOC, their birthing outcomes and factors associated with SOC changes.

METHODS

a longitudinal survey was conducted where women completed a questionnaire in the antenatal and postnatal period. Questionnaire one provided information on SOC scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. Questionnaire two provided information on SOC scores, EPDS scores and birthing outcomes.

FINDINGS

1074 women completed questionnaire one and 753 women completed questionnaire two. Compared to women with low antenatal SOC, women with high antenatal SOC were less likely to experience caesarean section (OR 0.437 95% CI 0.209-0.915) and more likely to experience assisted vaginal birth (AVB) (OR 3.108 95% CI 1.557-6.203). Higher birth satisfaction, higher antenatal EPDS scores and lower antenatal SOC were associated with an increase in SOC. Epidural, AVB and decreased birth satisfaction were associated with a decrease in SOC.

CONCLUSION

high sense of coherence in pregnant women is associated with half the likelihood of caesarean section compared to women with low sense of coherence. Women׳s sense of coherence is raised and lowered by degree of satisfaction with their births and lowered by some labour interventions.