Measurement of maternal perceptions of support and control in birth (SCIB)

The Relationship of the Traumatic Birth Perception of Women with Birth Memories and Recall

BACKGROUND

A traumatic childbirth experience can have both short- and long-term health and well-being consequences for the woman and her family. If a woman experiences traumatic childbirth and retains negative memories for a long time, this may impact her future childbirth experience, mother-infant bonding and breastfeeding problems, and her relationship with other family members.

AIM

The research was conducted to evaluate the relationship between women's traumatic birth perception and birth memory and recall.

MATERIAL AND METHOD

This descriptive study was conducted at Erzurum Research Hospital between August 16 and October 2021. Two hundred sixty women who met the inclusion criteria were included in the study sample. The personal information protocol, "Traumatic Childbirth Perception Scale," and "Birth Memories and Recall Questionnaire" were used to collect data.

RESULTS

The participants' mean age was 30.13 ± 5.85, and 43.4% had their first birth. Of the participants, 45% had one living child, 72.9% had a planned pregnancy, and 62.8% had a normal birth. Whereas more than a third of women in the study perceived childbirth and childbirth processes as moderately traumatic, another third had a high and very high perception. The birth memories and recall mean scores of the mothers within the scope of the study were 81.09 ± 22.69. According to the study results, it was determined that women's birth memories and recall were negatively affected as their traumatic childbirth perceptions increased.

CONCLUSION

It is possible to reduce traumatic childbirth perception with the continuous care and support provided by midwives during childbirth. Improving women's traumatic childbirth perception will also positively impact women's long-term memories of childbirth experience.

Impact of trauma, support, and control perceptions during childbirth on post-traumatic stress disorder among Syrian immigrant adolescent pregnant women

OBJECTIVE

The probability of experiencing mental health problems in the perinatal period is high for adolescent women. Immigration is a complicated phenomenon that increases the risk of encountering temporary or permanent psychological problems. This study aims to determine Syrian immigrant adolescent women's support and control perception levels during childbirth, birth trauma levels, and posttraumatic stress disorder incidence and affecting factors.

METHODS

This study used a prospective cohort design and was conducted in a hospital in Adana, a city in southern Turkey, between February and April 2022. It included 122 Syrian adolescent immigrant women, and data were collected in two interviews. While the first interview was conducted within the first 24 hours following birth, the second interview was conducted one month after birth. Data were collected through structured interviews using standardized questionnaires, including the Personal Information Form, the City Birth Trauma Scale, the Support and Control in Birth Scale, and the Post-traumatic Stress Disorder Checklist for DSM-5.

FINDINGS

The average age of participating women was 17.40±0.94. The participants' Perceived Support and Control in Birth Scale total score was 100.55±20.12, the City Birth Trauma Scale total score was 43.11±13.29, and the Post-traumatic Stress Disorder Checklist total score was 30.36±16.86. Of all the participating women, 26% were found to have post-traumatic stress disorder symptoms in the postpartum period. A relationship was found between support and control perceptions during childbirth and post-traumatic stress disorder symptoms.

CONCLUSION

This study found that immigrant adolescent women's support and control perceptions during childbirth were better than expected, and they had a high level of perceived trauma during childbirth. The presence of birth trauma emerged as a robust predictive factor for posttraumatic stress disorder, underscoring its critical role in maternal mental health. A positive childbirth experience, which is important for all women, has become an increasing need for immigrant women. There is a need for developing and sustaining health policies guaranteeing culturally sensitive care to prevent immigrant women from having a traumatic birth experience.

The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial

Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.

Development, woman-centricity and psychometric properties of maternity patient-reported experience measures: a systematic review

OBJECTIVE

Valid and reliable maternity patient-reported experience measures are critical to understanding women's experiences of care. They can support clinical practice, health service and system performance measurement, and research. The aim of this review is to identify and critically appraise the risk of bias, woman-centricity (content validity), and psychometric properties of maternity patient-reported experience measures published in the scientific literature.

DATA SOURCES

MEDLINE, CINAHL Plus, PsycINFO, and Embase were systematically searched for relevant records between January 1, 2010 and July 10, 2021.

STUDY ELIGIBILITY CRITERIA

We searched for articles describing the instrument development of maternity patient-reported experience measures and measurement properties associated with instrument validity and reliability testing. Articles that described patient-reported experience measures developed outside of the maternity context and articles that did not contribute to the instruments' development, content validation, and/or psychometric evaluation were excluded.

METHODS

Included articles underwent risk of bias, content validity, and psychometric properties assessments in line with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidance. Patient-reported experience measure results were summarized according to language subgroups. An overall recommendation for use was determined for each patient-reported experience measure language subgroup.

RESULTS

A total of 54 studies reported on the development and psychometric evaluation of 25 maternity patient-reported experience measures, grouped into 45 language subgroups. The quality of evidence underpinning the instruments' development was generally poor. Only 2 (4.4%) patient-reported experience measures reported sufficient content validity, and only 1 (2.2%) received a level "A" recommendation, required for real-world use.

CONCLUSION

Maternity patient-reported experience measures demonstrated poor-quality evidence for their measurement properties and insufficient detail about content validity. Future maternity patient-reported experience measure development needs to prioritize women's involvement in deciding what is relevant, comprehensive, and comprehensible to measure. Improving the content validity of maternity patient-reported experience measures will improve overall validity and reliability and facilitate real-world practice improvements. Standardized patient-reported experience measure implementation also needs to be prioritized to support advancements in clinical practice for women.

Persian version of the support and control in birth questionnaire among Iranian women

BACKGROUND

Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women.

MATERIALS AND METHODS

Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool.

RESULTS

Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items.

CONCLUSION

Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population.

Forms of Support and Experiencing Maltreatment and Disrespect During Childbirth at a Health Facility: A Self-Reported Cross-Sectional Study in Ghana

One method to enhance maternal health outcomes in underdeveloped nations is to help women and encourage them to give birth in medical facilities (skilled delivery). Yet, impediments to facility birth have reportedly included fear of abuse and contempt during labour and delivery. The purpose of this study was to evaluate the self-reported experiences of postnatal women and the types of abuse and disrespect they encountered during delivery. One hundred and thirteen (313) women were chosen at random from three healthcare facilities in the Greater Accra area for a cross-sectional study. STATA 15 was used to analyze the data. According to the study, more than half of the postnatal women (54.3%) were urged to have support people present during labour and delivery. Approximately 75.7% said they had been mistreated in some way, with physical violence accounting for 19.8% and undignified care for 9.3%. About 7.7% (n  =  24) of the women were detained or confined against their will. The study's findings indicate that labour-related abuse and disrespect are common. Without improving the birthing experience for women, expanding medical facilities might not result in the skilled or facility-based deliveries that are intended. The quality of maternal health care should be monitored, and hospitals should train their midwives in providing excellent patient care (customer care).

Measuring women's empowerment during the perinatal period in high income countries: A scoping review of instruments used

Empowerment is acknowledged as a process facilitating those who are less powerful to be engaged in their problem identification, decision making and actions to gain control over their life. This is an important goal for women during the perinatal period in their transition to motherhood. A concept analysis of women's empowerment during the perinatal period found that psychological and social dimensions play a role in women's perinatal empowerment and identified several defining attributes. The aim of this study was to identify robust validated instruments that measure all the attributes of women's empowerment during the perinatal period. We did a scoping review of scientific literature following the methodology of the JBI Reviewer's Manual. We searched the database MEDLINE, CINAHL, PsycINFO, PsycARTICLES and SocINDEX and selected papers meeting the inclusion criteria. Instruments measuring empowerment or related concepts were identified in the selected papers. Two authors independently cross referenced the items of each instrument against the defining attributes for empowerment. Our search resulted in 9771 unique hits of which 36 papers were finally included. Studies were from various countries with a wide variety of aims, demographics of cohorts and timepoints across the perinatal period. Twenty-one different instruments were used to measure empowerment, of which 11 were validated among women during the perinatal period. However, no identified instrument was developed specifically for women during the perinatal period or included all the dimensions of empowerment and the defining attributes. There is a need for a theoretically sound valid and reliable instrument measuring all the dimensions of empowerment of women during the perinatal period. Once developed this instrument needs testing with a broad range of women. Results from such a study will inform the development of appropriate interventions that have a coherent theoretical basis and are empirically informed to enhance women's empowerment during the perinatal period.

The relationship of childbirth experience with postpartum depression and anxiety: a cross-sectional study

BACKGROUND

The childbirth experience is a personal life event that is influenced by physiologic and mental-psychological processes. Due to the prevalence of psychiatric problems after childbirth, it is important to recognize the factors affecting women's emotional reactions. This study was conducted to define the relationship of childbirth experience with postpartum anxiety and depression.

METHODS

This cross-sectional study was conducted on 399 women from 1 to 4 months after their childbirth who were referred to health centers in Tabriz-Iran from January 2021 to September 2021. Socio-demographic and obstetric characteristics questionnaire, Childbirth Experience Questionnaire (CEQ 2.0), Edinburgh Postpartum Depression Scale (EPDS), and Postpartum Specific Anxiety Scale (PSAS) were used to collect the data. The general linear modeling was used along with adjustment of socio-demographic characteristics to determine the relationship between the childbirth experience with depression and anxiety.

RESULTS

The mean (SD) of the overall score for childbirth experience, anxiety, and depression were 2.9 (0.2) (score range: 1 to 4), 91.6 (4.8) (score range: 0 to153), and 9.4 (0.7) (score range: 0 to 30), respectively. There was a significant inverse correlation between the overall score of childbirth experiences, the depression score (r= -0.36, p < 0.001), and the anxiety score (r= -0.12, p = 0.028) based on the Pearson correlation test. According to the general linear modeling and with adjustment of socio-demographic characteristics, with the increasing score of the childbirth experience, the depression score decreased (B= -0.2; 95%CI: -0.3 to -0.1). Moreover, the variable of control during pregnancy was a predictor for postpartum depression and anxiety, so in women with the control during pregnancy, the mean score of postpartum depression (B= -1.8; CI 95%: -3.0 to -0.5; P = 0.004) and anxiety (B=-6.0; CI 95%: -10.1 to -1.6; P = 0.007) was less.

CONCLUSION

Based on the study results, postpartum depression and anxiety are related to childbirth experiences, therefore considering the effects of mothers' mental health on other aspects of a woman and her family's life, the core role of health care providers and policymakers in creating positive childbirth experiences is determined.

The effect of shared decision-making in choosing the method of labor analgesia on childbirth experience among primiparous women

BACKGROUND

Childbearing women reported moderate and sometimes low levels of autonomy in decision-making with their health care providers especially about their pain relief type and which may affect their childbirth experience. There is limited evidence about the effect of shared decision-making about childbirth pain relief on childbirth experience and satisfaction.

OBJECTIVE

The present study aimed to assess the effect of shared decision-making in choosing the method of labor analgesia on childbirth experience and satisfaction among primiparous women.

METHODS

This interventional study was conducted on 66 primiparous women with 38-42 weeks gestational age and with symptoms of labor and childbirth onset. Women were assigned into the intervention and control groups in a ratio of 1: 1 using blocked randomization. The intervention group received shared decision making about the advantages and disadvantages of labor analgesia methods, and the control group received routine care. Questionnaires, including obstetrics and demographic characteristics, Labor Agentry Scale (LAS), McKay Childbirth Satisfaction Rating Scale (MCSRS), Support and Control In Birth (SCIB) were completed. Data were analyzed by SPSS24 software and independent t-test and ANCOVA were used.

RESULT

After the intervention, the mean score of childbirth experience in the intervention group was significantly higher than that in the control group [Mean Difference (MD): 6.77, 95% CI: 2.72 to 10.82, (P <0.001)]. Further, the mean score of childbirth satisfaction in the intervention group was significantly higher than that in the control group [MD: 19.06, 95% CI: 9.63 to 28.49, (P<0.001)]. The mean score of control and support during childbirth and its subscales in the intervention group was significantly higher than that in the control group after the intervention [MD: 17.21, 95% CI: 9.40 to 25.03, (P <0.001)].

CONCLUSION

It is recommended that mothers should be involved in treatment decisions during childbirth since they are considered an important part of providing care during labor and childbirth.

Development of the short form Iranian women childbirth experience questionnaire: a confirmatory factor analysis approach item reduction

INTRODUCTION

Considering that childbirth experience has short- and long-term effects on women's lives, it is necessary to examine their delivery experiences. This study aimed to prepare the short form of a 52-item Iranian women's childbirth experience questionnaire with seven factors: professional support, preparation, control, positive perception, baby, family support, and fear.

METHODS

This methodological research was conducted on women aged 15 to 49 years (n = 770) with uncomplicated vaginal delivery. The short form of the Iranian women's childbirth experience questionnaire was prepared in four stages. The first stage was exploratory factor analysis, conducted on 250 samples, the second stage was confirmatory factor analysis which was performed on 260 samples, independent of the first stage, to report goodness and fit indices, and the third stage employed items from modification indices, expected parameter change, and standardized residual covariance, leading to the short form of Iranian women childbirth experience questionnaire. Finally, confirmatory factor analysis was run on 260 samples, independent of the previous two stages, to confirm the short form and compare it with the original questionnaire for psychometric analysis.

RESULTS

In the exploratory factor analysis stage, nine items with a factor load of less than 0.4 were removed, and the number of domains was reduced to five. The second stage showed that the questionnaire had a goodness of fit index. However, the third stage resulted in removing 11 overlapping items and making a short questionnaire with 33 items. Finally, the confirmatory factor analysis in the last stage showed appropriate goodness of fit for the short form of the Iranian women's childbirth experiences questionnaire (𝛘²/df = 2.352, CFI = 0.881, PCFI = 0.750, RMSEA = 0.072, SRMR = 0.0862).

CONCLUSION

The short form of the Iranian women's childbirth experiences questionnaire enjoyed from an appropriate psychometric evaluation. It is recommended when applying the original questionnaire is not feasible due to lack of time.

Women's sense of control during labour and birth with epidural analgesia: A qualitative descriptive study

BACKGROUND

Sense of control during childbirth is a critical issue concerning the association between high-quality maternity care and infant health. This study explored the facilitators of or barriers to a sense of control and the need for interventions to raise women's experience in childbirth.

METHODS

The data came from 17 participants. Data collection was conducted in the childbirth room and within three days following childbirth, respectively. For tackling the research problems, participant observation and interviewing were applied. Thematic analysis was applied to the data analyzed.

RESULTS

Two themes were identified: (1) facilitators of or barriers to practice a sense of control and (2) Care needed for a sense of control. The effectiveness of a sense of control is related to energy refill, mental loading subsided, control over decisions, non-pharmacological usage, and support from the meaningful person. Care needed includes showing empathy, providing information, using complementary pain-relief strategies, and adjusting care by parturient conditions.

CONCLUSION

This study highlights the influencing factors and interventions relating to women's sense of control during childbirth with epidural analgesia. The findings suggest that many approaches, such as white noise, benefit women's sense of control after an epidural. Using non-pharmacological methods, such as a birth ball, should be appropriately regulated by situations to enhance women's sense of control. Through the assessment, education, attention to maternal needs, and recognizing the barriers to a sense of control, women will benefit from the interventions designed to improve their sense of control during childbirth.

Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial

BACKGROUND

The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes.

METHODS

This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze.

RESULTS

The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group.

CONCLUSION

This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020.

Correlations Between Primiparous Women’s Perceived Internal Control, External Control, Support and Their Birth Experience

BACKGROUND

Perceived control and support can contribute to a positive childbirth experience. However, most studies have not differentiated between perceived internal and external control.

OBJECTIVE

The present study aimed to assess primiparous women’s perceived internal control, external control, and support, including family and professional support and their association with the childbirth experience.

METHODS

A cross-sectional study was carried out on 800 primiparous mothers recruited from health centers across Tabriz, Iran, through cluster sampling. The childbirth experience questionnaire (2.0) and the support and control in birth scale were used to measure women’s childbirth experience and their perceived internal and external control and support. Data were collected through an interview during early postpartum and analyzed by independent t-test, one-way ANOVA, Pearson correlation and general linear model.

RESULTS

The results demonstrated a significant correlation between perceived internal control (r = 0.80, p < .001), external control (r = 0.79, p < .001) and professional support (r = 0.83, p < .001) with childbirth experience. By controlling confounders such as socio-demographic and reproductive variables, internal control [β (95% CI): 0.28 (0.25 to 0.31); p < .001], external control [0.10 (0.06 to 0.14); p < .001], professional support [0.27 (0.23 to 0.30); p < .001], were independent predictors of positive childbirth experience.

CONCLUSION

These findings point to the importance of perceived internal, external control and professional support and the relationship between healthcare providers, especially midwives, with the women in improving childbirth experience. It is suggested that healthcare providers give support to women and utilize methods that enhance women’s control during labor and childbirth.

Psychometric validation of a patient-reported experience measure of obstetric racism© (The PREM-OB Scale™ suite)

BACKGROUND

Perinatal quality improvement lacks valid tools to measure adverse hospital experiences disproportionately impacting Black mothers and birthing people. Measuring and mitigating harm requires using a framework that centers the lived experiences of Black birthing people in evaluating inequitable care, namely, obstetric racism. We sought to develop a valid patient-reported experience measure (PREM) of Obstetric Racism^© in hospital-based intrapartum care designed for, by, and with Black women as patient, community, and content experts.

METHODS

PROMIS© instrument development standards adapted with cultural rigor methodology. Phase 1 included item pool generation, modified Delphi method, and cognitive interviews. Phase 2 evaluated the item pool using factor analysis and item response theory.

RESULTS

Items were identified or written to cover 7 previously identified theoretical domains. 806 Black mothers and birthing people completed the pilot test. Factor analysis concluded a 3 factor structure with good fit indices (CFI = 0.931-0.977, RMSEA = 0.087-0.10, R²  > .3, residual correlation < 0.15). All items in each factor fit the IRT model and were able to be calibrated. Factor 1, "Humanity," had 31 items measuring experiences of safety and accountability, autonomy, communication, and empathy. A 12-item short form was created to ease respondent burden. Factor 2, "Racism," had 12 items measuring experiences of neglect and mistreatment. Factor 3, "Kinship," had 7 items measuring hospital denial and disruption of relationships between Black mothers and their child or support system.

CONCLUSIONS

The PREM-OB Scale™ suite is a valid tool to characterize and quantify obstetric racism for use in perinatal improvement initiatives.

The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study

Background

There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women.

Methods

A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention.

Results

After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001].

Conclusion

Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

Predictors of maternal role adaptation in Iranian women: a cross-sectional study

BACKGROUND

Numerous factors play a role in maternal identity formation and function. Recognizing the aspects related to adaptation to the mother role can effectively provide a solution to help mothers construct maternal roles. Consequently, this study aimed to determine the predictors of adaptation to the maternal role in Iranian women.

METHODS

This cross-sectional study was performed on 564 women who gave birth within one to four months after delivery with a record in Tabriz-Iran health centers, 2020-21. Participants were selected by cluster sampling. Data were collected using questionnaires of socio-demographic and obstetrics characteristics, Birth Satisfaction Scale-Revised (BSS-R), Lipz Maternal Self-Confidence Scale (LMSCS), and maternal role adaptation questionnaire. The general linear model was used to estimate the effect of each of the independent variables (socio-demographic and obstetrics characteristics, childbirth satisfaction, and self-confidence) on the dependent variable (maternal role adaptation).

RESULTS

The mean (± SD) total scores of adaptation to the maternal role, childbirth satisfaction, and maternal self-confidence were 77.4 (± 15.2) (score range: 33-165), 17.0 (± 5.9) (score range: 0-40), and 65.1 (± 13.5) (score range: 24-144), respectively. Based on the Pearson correlation test, there was a significant direct correlation between the overall score of adaptation to the maternal role with childbirth satisfaction (r = 0.462, P < 0.001) and maternal self-confidence (r = 0.652, P < 0.001). Based on the adjusted general linear model, the variables of maternal self-confidence, childbirth satisfaction, adequacy of household income, and spouse support were predictors of adaptation to the mother role. They explained 50.6% of the variance in the adaptation to the mother role score.

CONCLUSIONS

Concerning the study results, adaptation to the maternal role is related to childbirth satisfaction and some socio-demographic variables. Therefore, considering the impact of maternal role on other aspects of women's life and child care, healthcare providers' and policymakers' critical role is to create positive childbirth experiences and strengthen mothers' self-confidence.

The Role of Personality Traits and Delivery Experience in Fear of Childbirth: A Prospective Study

This study aimed to examine fear of childbirth (FOC) before and after delivery in relation to personality (anxiety and anxiety sensitivity) and birth experience (type of delivery, pain, and staff support). One-hundred and five women completed questionnaires during pregnancy and one month after childbirth. Participants completed the Wijma Delivery Expectancy/Experience Questionnaire; the State and Trait Anxiety Inventory and Anxiety Sensitivity Index, and the McGill Pain Questionnaire and a Support from staff questionnaire. FOC levels decreased after childbirth, but only in the high-level fear group. Path analysis showed that physical concerns, one aspect of anxiety sensitivity, shape FOC during pregnancy. Together with interventions at delivery (instrumental vaginal delivery and emergency caesarean section), pain and low staff support, this in turn modifies FOC after delivery. In conclusion, FOC decreases after childbirth. However, combined with adverse birth experience and certain personality traits, FOC during pregnancy affects FOC after delivery.

Experience of early motherhood during the first wave of the COVID-19 pandemic in Northern Germany: a single-centre before and after comparison

PURPOSE

To assess maternal mental health during the first weeks after birth including birth experience, postpartum adjustment to early motherhood and the perception of newborn behaviour, and how this may be influenced by the first wave of the COVID-19 pandemic.

METHODS

Ninety women who gave birth after the first enforcement of nation-wide disease control restrictions in Germany between 16 March and 10 May 2020 were surveyed and compared with 101 women who had given birth before the pandemic. Information on maternal mental health and maternal perception of early motherhood and neonatal behaviour were assessed at 3-8 weeks postpartum.

RESULTS

Mothers who gave birth under the COVID-19-associated disease control restrictions did not show significant differences in depression, anxiety and social support scales compared to mothers before the pandemic. Birth experience was similar, while support during birth was perceived to be higher under the COVID-19 restrictions. Confidence in caretaking of the newborn and perception of neonatal behaviour were comparable between the two groups. Mothers expressed significantly higher dissatisfaction with the maternal role during the pandemic.

CONCLUSIONS

Overall, maternal mental health and the perception of the newborn and early caretaking during the first COVID-19 wave did not substantially differ from the perceptions of mothers before the pandemic. A potential influence of the pandemic on higher dissatisfaction with the maternal role may be associated with the pandemic conditions affecting everyday life and should be addressed in postpartum care and in future qualitative and longitudinal studies.

Postpartum Post-Traumatic Stress Symptoms Following Cesarean Section-the Mediating Effect of Sense of Control

Our aim is to clarify the differences in post-traumatic symptom levels between women who had emergency cesarean sections (C-sections) and women who had elective ones and investigate the function of sense of control in post-traumatic symptoms development. On the fourth day after the C-section, participants were recruited and completed a demographic and background questionnaire. Six to eight weeks later, they received continuation questionnaires. A total of 161 women who underwent Cesarean-sections participated in the study's final sample. Women above the age of 18, who gave birth by elective or emergency cesarean-sections were included. Post-traumatic symptoms were measured by the post-traumatic stress disorder checklist for DSM-5 (PCL-5), and sense of control was measured by the Support and Control in Birth (SCIB) questionnaire. Demographic and background data were also taken. The relationship between the type of cesarean section and the post-traumatic symptom levels was fully mediated by the sense of internal control. Women who underwent emergency cesarean-sections experienced lower levels of internal control than women who had elective ones, which in turn, correlated negatively with post-traumatic symptom levels. The mediation model explained 38.5% of the variance in post-traumatic symptoms levels. An internal sense of control is important in reducing post-traumatic symptoms, especially among women undergoing emergency cesarean-sections. The medical team should develop an awareness of the importance of gaining an internal sense of control by including the antenatal woman in decision-making as much as possible. By explaining and normalizing physical and mental feelings, physicians can possibly reduce the prevalence and severity of postpartum post-traumatic symptoms.

Recommendations for improving primiparous women's childbirth experience: results from a multiphase study in Iran

BACKGROUND

Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births.

METHODS/DESIGN

The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members.

RESULTS

The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique.

CONCLUSION

Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.

Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study

BACKGROUND

Wireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have.

AIM

To gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction.

METHODS

A convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding.

FINDINGS

Women using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of 'Being Free, Being in Control', 'Enabling and Facilitating' and 'Maternity Unit Culture'. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups.

CONCLUSIONS

When CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience.

Development and psychometric properties of Iranian women childbirth experience questionnaire

Aim

This study aimed to develop and psychometrics a questionnaire for assessing childbirth experience in Iranian women.

Design

Cross‐sectional study.

Methods

This cross‐sectional study was done in women who experienced childbirth within the last 12 hr to 2 months from May to December 2018. Questionnaire items were extracted from a comprehensive review of the available studies and questionnaires on childbirth experiences and definitions implied by qualitative interviews. The designed questionnaire was validated in three stages: face, content and construct. Cronbach's alpha was used to determine the reliability of the instrument.

Result

Iranian women childbirth experience questionnaire contained seven factors with 52 items which were called professional support, husband's and other important support, baby, preparation, fear, positive perception and control were extracted. The Cronbach's alpha coefficient after factor analysis was 0.62–0.92 and for the whole instrument was 0.91. The findings showed that Iranian women childbirth experience questionnaire was valid and reliable.

Psychometric properties of the Iranian version of Birth Satisfaction Scale-Revised

Background:

The precise measurement of childbirth satisfaction demands a reliable tool specifically designed for maternal care and birth satisfaction. It was designed to measure the degree of women's satisfaction with childbirth. The purpose of the present study was to translate and analyze the psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) in Iranian women.

Materials and Methods:

This is a methodological cross-sectional study. Five health centers in various regions of Kashan were affiliated to Kashan University of Medical Sciences, Kashan, Iran. Two hundred and twelve mothers who were referred to the health centers and had childbirth during the last year were included. The face and content validity were obtained after backward–forward translation of the Iranian version of BSS-R by 12 faculty board members in midwifery and reproductive health fields. The construct validity of the tool was determined using confirmatory factor analysis on 212 women in the postpartum period. The internal consistency and reliability of the tool was evaluated by Cronbach's alpha coefficient and intraclass correlation coefficient (ICC). The collected data were analyzed in SPSS (version 16.0) and EQS 6.1.

Results:

The result of face and content validity was minor modifications in some words. Confirmatory analysis results indicated that there was an acceptable fit with a three-factor model. Cronbach's alpha was estimated for the whole tool 0.74, and the alpha of the three subscales ranged from 0.698 to 0.801. ICC for determining reliability was 0.77.

Conclusion:

The Iranian version of BSS-R was a reliable and valid tool for assessing the women's satisfaction with their childbirth care.

Adaptation of short version of questionnaire for assessing the childbirth experience (QACE) to the Iranian culture

BACKGROUND

Given the importance of the childbirth experience, its effects on women's life and society, and the need for its assessment by accurate instruments, this study aimed to determine the psychometric properties of the Questionnaire for Assessing the Childbirth Experience (QACE) in an Iranian women population.

METHODS

The validity of the Farsi edition of the questionnaire was assessed using the opinions of eight experts. Its construct validity was assessed by studying 530 mothers, at 1-4-month postpartum, who delivered in health centers of Tabriz, Iran. The exploratory factor analysis (EFA) was performed to identify its factors. Then, the confirmatory factor analysis (CFA) was performed for the structural assessment of the extracted factors. Spearman's correlation coefficient was used to investigate the correlation between factors. Cronbach's alpha and intraclass correlation coefficient (ICC) were used to obtain the internal consistency and test-retest reliability.

RESULTS

In total, four factors were extracted from the EFA: "relationship with staff" (4 questions), "first moments with the newborn" (3 questions), "feelings at one-month postpartum" (3 questions), and "emotional status" (3 questions). According to the CFA, the model achieved desired fit level (RMSEA < 0.08, GFI, CFI, IFI > 0.90, and x²/df < 5.0). Cronbach's alpha (0.77-0.82) and intraclass correlation coefficient index (0.83-0.98) were desirable for all factors.

CONCLUSION

The short edition of the QACE, as a standard tool, can be used by future studies to measure the experience of Iranian women.

Maternal Sense of Control During Childbirth and Infant Feeding Method

OBJECTIVE

To estimate whether maternal sense of control in labor is associated with breastfeeding at 4-8 weeks postpartum.

METHODS

This is a secondary analysis of data from a multicenter randomized controlled trial of elective induction of labor at 39 weeks of gestation in low-risk nulliparous women. In this trial, women completed the Labor Agentry Scale, a validated measure of women's feelings of control over the childbirth process, 6-96 hours after delivery. The Labor Agentry Scale score, which is higher with more perceived control during childbirth, was analyzed both as a continuous and a categorical variable (quintiles). Self-reported breastfeeding at 4-8 weeks postpartum was categorized as exclusive breastfeeding, breastfeeding and formula feeding, or exclusive formula feeding. Women were included in this analysis if they labored, filled out a Labor Agentry Scale questionnaire, had a neonate who survived until the postpartum visit, and provided information on infant feeding. Multinomial logistic regression was used to adjust for confounders.

RESULTS

Of 5,185 women, 32.9% (n=1,705) were exclusively breastfeeding, 31.2% (n=1,620) were breastfeeding and formula feeding, and 35.9% (n=1,860) were exclusively formula feeding 4-8 weeks after delivery. Overall Labor Agentry Scale score ranged from 34 to 203 (median 167, interquartile range 145-182). The median Labor Agentry Scale score was 169 (interquartile range 151-183) for women exclusively breastfeeding, 166 (interquartile range 142-182) for women who were breastfeeding and formula feeding, and 164 (interquartile range 142-181) for women who were only formula feeding (P<.001). In the unadjusted multinomial model, women with Labor Agentry Scale scores in the lowest two quintiles (ie, those with lower perceived control during childbirth) were less likely to be exclusively breastfeeding (as compared with those exclusively formula feeding) than women in the highest Labor Agentry Scale quintile. When controlling for confounders, however, this association was no longer significant.

CONCLUSION

After adjustment for confounders, perceived control during childbirth was not associated with breastfeeding at 4-8 weeks postpartum among nulliparous women.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, NCT01990612.

Positive childbirth experience: A qualitative study

Aim

This study aimed to explore the meaning of a positive childbirth experience expressed by women who had given birth in Iran.

Design

Qualitative exploratory study.

Methods

This is a qualitative study conducted on 10 women aged 20-38 years with positive childbirth experience. Data were collected using semi-structured interviews from 72 hr-2 months after childbirth.

Results

Data analysis led to into two themes and five subthemes. The themes include control and empowerment. Control theme consisted of three subthemes of preparation, coping and support; and empowerment theme consisted of two subthemes of self-efficacy and self-esteem. Women's sense of empowerment to childbirth can be the result of a positive childbirth experience. Therefore, it seems that providing positive experience factors of childbirth plays an important role in women's self-efficacy and self-esteem, which requires cooperation and effort at the level of the individual, family, education system and healthcare system.

Psychometric testing of the support and control in birth scale

Background

The Support and Control in Birth (SCIB) scale primarily measures the perceived support and control of expectant mothers during childbirth, thereby obtaining an understanding of their birth experiences. The advantages of this scale are its good reliability and validity and that it consolidates birth support and control. However, a Chinese version of the scale has yet to be developed. Therefore, this study sought to evaluate the validity and reliability of a Chinese version of the Support and Control in Birth Scale (C-SCIB).

Methods

A total of 228 postpartum women participated in this study. The C-SCIB scale was developed through a translation and back translation, followed by an evaluation of its content validity by a group of experts. Cronbach’s α internal consistency and test-retest reliability were used to test the reliability of the scale. In addition, criterion-related validity (predictive validity and concurrent validity) and construct validity were used to test the validity of the scale.

Results

The C-SCIB scale showed good results in terms of the item-level and scale-level content validity indices. The Cronbach’s α internal consistency was 0.81, and its test-retest reliability was 0.96. The confirmatory factor analysis results showed the overall goodness-of-fit was parsimony fit indices. The predictive validity analysis showed a significant positive correlation between the C-SCIB scale and the Questionnaire Measuring Attitudes About Labor and Delivery (r = 0.31, p < 0.01). Furthermore, the concurrent validity analysis showed a significant and moderate correlation between the C-SCIB and the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (r = 0.49, p < 0.01) as well as the Labor Agentry Scale (r = 0.51, p < 0.01).

Conclusion

The C-SCIB scale was proven to have good reliability and validity, and thus can be used to measure the degree of support and the locus of control perceived by expectant women during labor.

Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol

Background

The childbirth experience has significant effects on the life of the mother and family. However, there are no Iranian studies which evaluate and measure women’s childbirth experiences to provide accurate data on this important matter. The aim of this study is to develop a new guideline to improve women’s childbirth experiences by meeting their needs and expectations.

Methods/design

The present study will use the mixed method with the explanatory sequential approach. Phase one is a cross-sectional survey with random cluster sampling of the health centers in Tabriz. Eight hundred primiparous women will be selected to measure their childbirth experiences and predictors factors. Phase two is a qualitative study to explore women’s perceptions of the aspects and determinants of the childbirth experience. Phase two participants will be selected using purposive sampling from the women who participated in phase one. Phase three involves developing a new guideline to improve women’s childbirth experiences. The new guideline will be developed based on the following elements: a) the results of the qualitative and quantitative data from phase one and two, b) a review of the related literature, and c) expert opinions that have been collected using the Delphi technique.

Discussion

By exploring women’s childbirth experiences and the influencing factors, a culturally sensitive evidence-based guideline can be developed. The provision of the evidence-based guideline resulting from this study might be effective in improving the quality care of the services for pregnant women.

Ethical code

IR.TBZMED.REC.1396.786.

Trial of healthy relationship initiatives for the very early years (THRIVE), evaluating Enhanced Triple P for Baby and Mellow Bumps additional social and care needs during pregnancy and their infants who are at higher risk of maltreatment: study protocol for a randomised controlled trial

BACKGROUND

Growing evidence suggests that experiences in the early years play a major role in children's development in terms of health, wellbeing and educational attainment. The Trial of healthy relationship initiatives for the very early years (THRIVE) aims to evaluate two antenatal group interventions, Enhanced Triple P for Baby and Mellow Bumps, designed for those with additional health or social care needs in pregnancy. As both interventions aim to improve maternal mental health and parenting skills, we hypothesise that in the longer term, participation may lead to an improvement in children's life trajectories.

METHODS

THRIVE is a three-arm, longitudinal, randomised controlled trial aiming to recruit 500 pregnant women with additional health or social care needs. Participants will be referred by health and social care professionals, predominately midwives. Consenting participants will be block randomised to one of the three arms: Enhanced Triple P for Baby plus care as usual, Mellow Bumps plus care as usual or care as usual. Groups will commence when participants are between 20 and 34 weeks pregnant.

DISCUSSION

The population we aim to recruit are traditionally referred to as "hard to reach", therefore we will monitor referrals received from maternity and social care pathways and will be open to innovation to boost referral rates. We will set geographically acceptable group locations for participants, to limit challenges we foresee for group participation and retention. We anticipate the results of the trial will help inform policy and practice in supporting women with additional health and social care needs during antenatal and early postnatal periods. This is currently a high priority for the Scottish and UK Governments.

TRIAL REGISTRATION

International Standard Randomised Controlled Trials Number (ISRCTN) Registry, ISRCTN:21656568 . Registered on 28 February 2014 (registered retrospectively (by 3 months)).

Factors associated with women's desire for control of healthcare during childbirth: Psychometric analysis and construct validation

The desire for control of healthcare is a significant moderator of outcomes related to childbirth. Researchers have shown that a sense of control of healthcare during childbirth is strongly correlated with postpartum maternal well-being. The aims of this study were to examine (a) the psychometric characteristics of an instrument to assess women's desire for control of healthcare during childbirth, and (b) examine desire for control in relation to parity, medical complications of pregnancy, and women's choices of childbirth providers and setting. The study design was cross-sectional using two different samples totaling 385 pregnant women. In Sample 1, (n = 193) we conducted an exploratory factor analysis to reduce the initial item pool. In Sample 2, (n = 192) we conducted a confirmatory factor analysis (CFA) of the final 12-item instrument and examined factors related to the desire for control. Results of the analysis in Sample 1 were supportive of a single-factor structure reflecting women's desire to influence the childbirth healthcare environment and decision-making. The final 12-item instrument had high internal consistency reliability (Cronbach's alpha = 0.93). CFA in Sample 2 was supportive of the single-factor structure with good model fit. The desire for control was directly correlated with an internal locus of control. Nulliparous women reported a lower desire for control compared with multiparous women. The desire for control among women with self-reported medical complications of pregnancy was comparable to that among women without pregnancy complications. The desire for control was a predictor of choosing midwives (vs. obstetricians), home or birth center (vs. hospitals), and professional labor support (e.g., doulas). Implications for future research on the impact of desire for control on maternal health outcomes are discussed.

Birthing ball versus pethidine and haloperidol in satisfaction with childbirth

OBJECTIVE

To determine the effects on maternal satisfaction of the use of the birthing ball as a method of pain relief compared to the subcutaneous administration of pethidine (50mg) and haloperidol (2.5mg), during the latent phase of labour.

METHOD

Randomised, unicentric, parallel and controlled clinical trial.

PARTICIPANTS

Low-risk pregnant women hospitalised in a pathological pregnancy ward at the Gregorio Marañón University General Hospital (Madrid) due to prolonged pregnancy, premature rupture of membranes, or labour prodromes.

INTERVENTION

once the patient's labour had become painful, a series of pre-established movements were implemented with a birthing ball in the intervention group, or pethidine and haloperidol were administered at the same dose subcutaneously. After the intervention and on the post-natal ward, satisfaction was measured with the Mackey Satisfaction Childbirth scale, validated in Spanish in 2016, in the first 48-72hours after delivery.

ANALYSIS

group comparisons: Student's t for continuous variables and Chi-squared for categorical variables. Significance at p<0.05.

RESULTS

The maternal satisfaction was significantly higher in the experimental group than in the comparison group, in all the domains of the scale: obstetrician (4.24/3.87), dilatation (4.02/3.35), second stage (4.27/3.67), newborn (4.72/4.43), accompaniment and comfort (4.78/4.44). There were, however, no statistically significant differences in the midwife subscale, although the scores were equally high (4.65/4.45).

CONCLUSION

Using birthing balls during the latent phase of labour increases women's satisfaction with their labour process more than administering pethidine and haloperidol during this period.

Psychosocial factors that mediate the association between mode of birth and maternal postnatal adjustment: findings from a population-based survey

BACKGROUND

Mode of birth has been found to be associated with maternal postnatal adjustment with women who have Caesarean Sections (CS) thought to be at higher risk of emotional distress. However the relationship is complex and studies have demonstrated mixed findings. The aim of this study is to evaluate a model that explores the direct relationship between mode of birth and postnatal maternal adjustment at 3 months and indirect relationships through psychosocial variables.

METHODS

A secondary analysis of a population-based survey conducted in England, UK in 2014. The analysis included primiparous women with singleton babies who provided information about mode of birth (n = 2139).

RESULTS

Maternal postnatal adjustment, as measured by Maternal postnatal wellbeing and Satisfaction with care during labour and birth, varied by mode of birth. Women who had an unplanned CS had the poorest postnatal adjustment. Mode of birth was not associated with Maternal/infant sense of belonging. Four out of the five proposed mediation variables (Perceived control, Maternal expectation, Support in labour, How long until the mother held her baby), showed partial mediation of the relationship between mode of birth and both Maternal postnatal wellbeing and Satisfaction with care during labour and birth. The strongest mediator was Perceived control and the only variable not to show a significant mediation effect was Health of the infant at 3 months.

CONCLUSIONS

Birth by unplanned, but not planned, caesarean section was associated with poorer maternal adjustment and instrumental birth was associated with lower maternal satisfaction with labour and birth. These relationships were found to be partially mediated by psychosocial variables. Psychosocial interventions in the perinatal period should be considered to optimise maternal postnatal adjustment.

Women's experiences of induction of labour: Qualitative systematic review and thematic synthesis

OBJECTIVES

To explore and synthesise evidence of women's experiences of induction of labour (IoL).

DESIGN

Systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from inception to the present day. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool.

SETTING AND PARTICIPANTS

Low and high risk women who had experienced IoL in an inpatient or outpatient setting.

FINDINGS

Eleven papers (representing 10 original studies) published between 2010 and 2018 were included for thematic synthesis. Four key analytical themes were identified: ways in which decisions regarding induction were made; women's ownership of the process; women's social needs when undergoing IoL; and the importance of place in the induction process. The review indicates that IoL is a challenging experience for women, which can be understood in terms of the gap between women's needs and the reality of their experience concerning information and decision-making, support, and environment.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Providing good quality appropriately timed information and supporting women's self-efficacy to be involved in decision-making around IoL may benefit women by facilitating a sense of ownership or control of labour. Compassionate support from significant others and healthcare professionals in a comfortable, private and safe environment should be available to all women.

Women's perception of support and control during childbirth in The Gambia, a quantitative study on dignified facility-based intrapartum care

Background

In The Gambia, a woman faces 1 in 24-lifetime risk of maternal death due to pregnancy and childbirth, yet, only 57% of deliveries are conducted by skilled birth attendants. However, poor provider attitude has been identified as one of the contributing factors hampering the efforts of the government in improving access to skilled care during childbirth. This study, therefore, explored women’s perception of support and control during childbirth in The Gambia.

Methods

A descriptive cross-sectional study was employed. A convenience sampling method was used to select participants in two regions in The Gambia. A sample size of 200 women who met the eligibility criteria was recruited after informed consent. The demographic-obstetric information sheet and the Support and Control in Birth scale (SCIB) were used to collect data. Data analysis was done using SPSS software version 23.0.

Results

Women’s perceptions of support and control were low. External control 1.85 (SD ± 0.43) recorded the least perception compared to internal control 2.41 (SD ± 0.65) and perception of support 2.52 (SD ± 0.61). Participants reported the lowest perceptions in pain control, involvement in decision making, information sharing and the utilization of different position during birth. Women’s age (p < .001) and mode of delivery (p = .01), significantly predicted women’s perception of internal control. Educational status (p = .02), mode of delivery (p = .04), place of delivery (p < .001) and perception of support (p < .001) significantly predicted women’s perception of external control, whilst birth plan (p = .001), mode of delivery (p = .04), and perception of external control (p < .001) significantly predicted women’s perception of support.

Conclusion

This study concluded that an environment that promotes women feeling a sense of control and support during childbirth should be created in order to ensure a dignified intrapartum care in The Gambia. This can be achieved through effective training of skilled birth attendants on non-pharmacological pain management, effective communication with clients and promoting women’s participation in decision-making regarding their care throughout the process of childbirth.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-2025-5) contains supplementary material, which is available to authorized users.

Adult attachment and birth experience: importance of a secure base and safe haven during childbirth

Objective: Examine connections between mothers’ adult attachment and subjective birth experience in the context of parity and mode of delivery.

Background: Research has established a clear connection between adult attachment and birth experience. This study extended previous research with an in-depth self-report attachment measure examining different dimensions of mothers’ attachment representations and their relation to subjective birth experience.  Interactions between mode of delivery and parity were also considered. Method: Participants were 257 mothers who gave birth 4 days to 12 months prior to the study. Mothers’ mean age was 30.5 years, 61% primiparas, and 26% delivered by caesarean.  Participants completed an online survey with the Birth Experience Questionnaire, the Reciprocal Attachment Questionnaire, and demographic information.

Results: Hierarchical moderated regression analyses showed direct effects from adult attachment dimensions to mothers’ subjective birth experiences, specifically perceived availability, feared loss, separation protest, angry withdrawal, and compulsive careseeking. Interactions emerged for parity and/or mode of delivery for overall subjective birth experience, perceived control, perceived social support, and satisfaction.

Conclusion: Adult attachment representations related to subjective birth experience, indicating that attachment figures serve as secure bases and safe havens for mothers during childbirth. These results have implications for practitioners and provide direction for future research.

The evolution of birth medicalisation: A systematic review

First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth.

Anxiety and depressive symptoms during pregnancy, perceived control and posttraumatic stress symptoms after childbirth: A longitudinal mediation analysis

This longitudinal study evaluated the mediating role of sense of control during labour in the association between anxiety and depression levels during pregnancy and postpartum posttraumatic stress disorder symptoms. Participants were 57 women. Anxiety and depression were assessed during pregnancy; sense of control and childbirth-related posttraumatic stress disorder symptoms were collected 6-8 weeks after childbirth. Higher levels of anxiety and depression were associated with more postpartum posttraumatic stress disorder symptoms through lack of perceived control. For depression, this happened only for primiparous. Interventions targeting mechanisms enhancing perceptions/feelings of control should be offered to these women to prevent/minimize childbirth-related posttraumatic stress disorder.

A Systematic Review of Birth Experience Assessment Instrument

PURPOSE

This study aimed to conduct a systematic review and to describe characteristics of the birth experience assessment instrument.

METHODS

Literature related to the development of the birth experience assessment instrument was examined using a systematic review method. A literature search was conducted using the keywords as '[normal birth]; [satisfac* OR care quality]; [instrument OR scale] AND (development)' through PubMed, CINAHL, SCOPUS, PsycINFO, and RISS. The search used quality appraisal through QUADAS (Quality Assessment of studies of Diagnostic Accuracy included Systemic reviews) yielding 17 records.

RESULTS

The birth experience assessment instrument was categorized for instrumental characteristics: birth satisfaction (n=8), perception of labor experience (n=5), and birth care quality assessment in normal and operative birth experiences (n=4). Important key elements for content characteristics were as follows: nursing practice (n=10), pain control (n=5), environment (n=5), participation (n=4), and support (n=4).

CONCLUSION

This study demonstrated that the birth experience instrument is appropriate for measuring quality of birth care in various clinical conditions. This review of the birth experience instrument reports that an appropriate psychometric tool for enhancing quality of birth care is important.

Measuring women's childbirth experiences: a systematic review for identification and analysis of validated instruments

BACKGROUND

Women's childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women's experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women's childbirth experience.

METHODS

A systematic review was conducted in January 2016 with a comprehensive search in the bibliographic databases PubMed, CINAHL, Scopus, The Cochrane Library and PsycINFO. Included instruments measured women's childbirth experiences. Papers were assessed independently by two reviewers for inclusion, and quality assessment of included instruments was made by two reviewers independently and in pairs using Terwee et al's criteria for evaluation of psychometric properties.

RESULTS

In total 5189 citations were screened, of which 5106 were excluded by title and abstract. Eighty-three full-text papers were reviewed, and 37 papers were excluded, resulting in 46 included papers representing 36 instruments. These instruments demonstrated a wide range in purpose and content as well as in the quality of psychometric properties.

CONCLUSIONS

This systematic review provides an overview of existing instruments measuring women's childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.

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.

A systematic review of the relationship factor between women and health professionals within the multivariant analysis of maternal satisfaction

INTRODUCTION

personalised support provided to women by health professionals is one of the prime factors attaining women's satisfaction during pregnancy and childbirth. However the multifactorial nature of 'satisfaction' makes difficult to assess it. Statistical multivariate analysis may be an effective technique to obtain in depth quantitative evidence of the importance of this factor and its interaction with the other factors involved. This technique allows us to estimate the importance of overall satisfaction in its context and suggest actions for healthcare services.

METHODS

systematic review of studies that quantitatively measure the personal relationship between women and healthcare professionals (gynecologists, obstetricians, nurse, midwifes, etc.) regarding maternity care satisfaction. The literature search focused on studies carried out between 1970 and 2014 that used multivariate analyses and included the woman-caregiver relationship as a factor of their analysis.

RESULTS

twenty-four studies which applied various multivariate analysis tools to different periods of maternity care (antenatal, perinatal, post partum) were selected. The studies included discrete scale scores and questionnaires from women with low-risk pregnancies. The "personal relationship" factor appeared under various names: care received, personalised treatment, professional support, amongst others. The most common multivariate techniques used to assess the percentage of variance explained and the odds ratio of each factor were principal component analysis and logistic regression.

DISCUSSION

the data, variables and factor analysis suggest that continuous, personalised care provided by the usual midwife and delivered within a family or a specialised setting, generates the highest level of satisfaction. In addition, these factors foster the woman's psychological and physiological recovery, often surpassing clinical action (e.g. medicalization and hospital organization) and/or physiological determinants (e.g. pain, pathologies, etc.).

The Turkish version of perceived support and control in birth scale

OBJECTIVE

This is a methodological study carried out to evaluate the validity and reliability of the Turkish version of the Support and Control in Birth Scale (SCIB).

METHODS

This study included 339 post-partum women. The validity of the Turkish version of the scale was assessed in terms of content and construct validity. Reliability was evaluated using the internal consistency coefficient, the test-retest correlation coefficient and the item correlation between the subscales.

RESULTS

The internal consistency coefficient of the scale was 0.84 (p < 0.01). There were significant correlations between sub-scales (rho = 0.122, 0.129, 0.263, p < 0.05), and the test-retest correlation coefficient of the scale was also significant (rho = 0.86, α = 0.000). As in the original scale, a three-factor structure was examined, which explained 42.85% of the total variance. The model was verified by a confirmatory factor analysis.

CONCLUSION

The Turkish version of the SCIB is a reliable and valid instrument for measuring the perceived support and control during birth among Turkish women.

Validation of the Spanish version of Mackey childbirth satisfaction rating scale

Background

The “Mackey Childbirth Satisfaction Rating Scale” (MCSRS) is a complete non-validated scale which includes the most important factors associated with maternal satisfaction. Our primary purpose was to describe the internal structure of the scale and validate the reliability and validity of concept of its Spanish version MCSRS-E.

Methods

The MCSRS was translated into Spanish, back-translated and adapted to the Spanish population. It was then administered following a pilot test with women who met the study participant requirements. The scale structure was obtained by performing an exploratory factorial analysis using a sample of 304 women. The structures obtained were tested by conducting a confirmatory factorial analysis using a sample of 159 women. To test the validity of concept, the structure factors were correlated with expectations prior to childbirth experiences. McDonald’s omegas were calculated for each model to establish the reliability of each factor.

The study was carried out at four University Hospitals; Alicante, Elche, Torrevieja and Vinalopo Salud of Elche. The inclusion criteria were women aged 18–45 years old who had just delivered a singleton live baby at 38–42 weeks through vaginal delivery. Women who had difficulty speaking and understanding Spanish were excluded.

Results

The process generated 5 different possible internal structures in a nested model more consistent with the theory than other internal structures of the MCSRS applied hitherto. All of them had good levels of validation and reliability.

Conclusions

This nested model to explain internal structure of MCSRS-E can accommodate different clinical practice scenarios better than the other structures applied to date, and it is a flexible tool which can be used to identify the aspects that should be changed to improve maternal satisfaction and hence maternal health.

The Development and Psychometric Analysis of the Women’s Experience in Childbirth Survey

Background and Purpose: A woman’s perception of the childbirth experience has not been adequately measured. The purpose of the Women’s Experience in Childbirth Survey (WECS) is to provide a comprehensive measure of the experience for women having a vaginal birth. Methods: A cross-sectional design with 302 postpartum women analyzed the psychometric properties of the WECS. Validity was assessed using exploratory factor analysis and correlation to a self-rating of the overall experience. Results: Exploratory factor analysis identified four subscales consistent with the organizing framework. WECS scores and self-rated experience were significantly correlated r = .51, p < .01. Internal consistency α = .86 and temporal stability (r = .88, p < .001) are adequate. Conclusion: Initial analysis indicates sufficient reliability and validity for further development and testing.