Who is well after childbirth? Factors related to positive outcome

"Health challenges and midwifery support for new mothers after childbirth: A cross-sectional study in Sweden"

OBJECTIVE

This study aimed to investigate new mothers' self-rated and perceived health problems and complications; their reasons for, and the frequency of, emergency department visits; how emergency department visits were associated with sociodemographic and obstetric factors; and new mothers' experiences of received support from the midwifery clinic.

DESIGN

A cross-sectional survey.

SETTING AND PARTICIPANTS

The study was conducted at 35 of 64 midwifery clinics in Stockholm, Sweden. The study population consisted of 580 new mothers.

MEASUREMENT AND FINDINGS

Descriptive statistics and logistic regression were used. New mothers experience a range of different health problems and complications during the first four weeks after giving birth. Sixteen percent sought emergency care. The odds of seeking emergency care increased for women with higher age and poorer self-rated health. Sixty-three percent of the new mothers received support from a midwife in primary care within the first four weeks after childbirth. Mothers who did not receive the support they wanted, expressed a wish for earlier contact and better accessibility.

CONCLUSION AND IMPLICATION FOR PRACTICE

It is notable that 16 % of new mothers seek emergency care in the first weeks after childbirth. This study has practical implications for midwifery practice and policy. There is a need for tailored postnatal support strategies so that midwives potentially are able to mitigate emergency department visits. Further studies should look at whether the high number of emergency visits among new mothers varies throughout Sweden, and whether this may be a result of reduced time of hospital stay after childbirth or other factors.

Factors related to a positive childbirth experience - a cross-sectional study

BACKGROUND/AIMS

Giving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience.

DESIGN/METHODS

A digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation.

RESULTS

Overall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors.

CONCLUSION

Although Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.

Effect of childbirth experience on the psychological well-being of postpartum women in Accra, Ghana

BACKGROUND

Women's experience of childbirth can affect their mental health outcomes, many years after the delivery. Consequently, the World Health Organisation has provided recommendations to ensure women receive positive birth experiences during intrapartum care. Yet, negative childbirth experience is widespread in Ghana. This study examined the association between women's childbirth experience (i.e. own capacity, professional support, perceived safety, and participation) and their psychological well-being, and whether or not perceived social support and resilience moderate the childbirth experience - psychological well-being relationship.

METHODS

Mothers (N = 117) who had given birth in the past month and were receiving postnatal care at two health facilities in the Greater Accra Region of Ghana provided the data for the current analysis. Data were collected using the Childbirth Experience Questionnaire, WHO-5 Well-Being Index, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. Hierarchical Linear Regression was used to analyse the data.

RESULTS

Results showed that childbirth experience domains of own capacity and perceived safety were significantly, and positively associated with psychological well-being. The domains of professional support and participation were not associated with psychological well-being in this sample. Perceived social support and resilience did not moderate the association between childbirth experience and psychological well-being.

CONCLUSION

The results suggest that efforts by birth practitioners (i.e. midwives, obstetricians, and gynaecologists) to give Ghanaian women positive childbirth experiences through the encouragement of personal control over the birthing process as well as ensuring the safety of the birthing procedure and environment would provide women with optimal mental health outcomes.

Risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised

OBJECTIVE

To evaluate the risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised (BSS-R) questionnaire.

METHODS

A cross-sectional study including women who gave birth at a single tertiary hospital between February 2021 and January 1, 2022. Birth satisfaction was measured using the BSS-R questionnaire. Maternal, pregnancy, and delivery characteristics were collected. Negative birth experience was defined as a BSS-R score lower than the median. Multivariable regression analysis was used to examine the association between birth characteristics and negative birth experience.

RESULTS

A total of 1495 women answered the questionnaire and were included in the analysis; 779 women comprised the positive birth experience group and 716 women comprised the negative birth experience group. Prior deliveries, prior abortions, and smoking (adjusted odds ratio [aOR], 0.52 [95% confidence interval (CI), 0.41-0.66]; aOR, 0.78 [95% CI, 0.62-0.99]; aOR, 0.52 [95% CI, 0.27-0.99], respectively) were independently associated with lower risk of negative birth experience. Immigration, answering the questionnaires in person, and cesarean delivery were independently associated with increased negative birth experience risk (aOR, 1.39 [95% CI, 1.01-1.86]; aOR 1.37 [95% CI, 1.04-1.79]; aOR, 1.92 [95% CI, 1.52-2.41], respectively).

CONCLUSION

Parity, prior abortions, and smoking were associated with a lower risk of negative birth experience, while immigration, answering questionnaires in person, and cesarean delivery were associated with a higher risk of negative birth experience.

Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran

BACKGROUND

Understanding women's experience of birth planning is necessary for introducing and implementing this process in the Iranian maternity services. This study aims to explore perceptions of birth plan implementation in Iran from the perspective of women, their husbands, and clinicians.

METHODS

This qualitative study was conducted in Iran. Qualitative data were collected from November 2020 to March 2021 by conducting semi-structured in-depth interviews with ten mothers who prepared a birth plan, and 15 key informants (obstetricians, midwives, and husbands) who were involved in the implementation process of birth plans. Data were analyzed using conventional qualitative content analysis.

RESULTS

Data reduction process resulted in 380 codes that were categorized in 16 subcategories and five main categories. The main categories were "Guide and pattern of preparing for childbirth pathway", "Maternal empowerment and sense of triumph", "Facilitating and enhancing communication", "Successful transition to parenthood and women's satisfaction", and "Challenges associated with implementation of the birth plan". The overarching theme "Birth plan: The missing link in promotion of vaginal birth in Iran" was constructed from these categories.

CONCLUSION

Findings of this study highlight the effectiveness of the implementation of birth plan along with childbirth preparation classes for increasing the likelihood of a successful vaginal birth and promoting empowerment and satisfaction in women during the childbirth process. The findings of this study could pave the way for developing, introducing, and implementing of birth plan in Iran.

US county-level prevalence and spatial distribution of optimal birth outcomes 2018-2019

A shift in focus towards healthy reproductive outcomes may reveal opportunities for novel interventions and strategies to promote optimal health. Using variables from the National Center for Health Statistics restricted use natality files, we calculated Empirical Bayes smoothed (EBS) rates of optimal birth for the all live births-both overall and by maternal race/ethnicity-by applying the smoothing tool in GeoDa version 1.18.0.10 We defined counties achieving greater racial birth equity as those where the overall EBS optimal birth rate was greater than the national 75th percentile and the absolute difference between maternal racial/ethnic categories was smaller than the national 25th percentile difference. During the study period, 49.80% of overall births could be classified as an optimal birth according to the study definition. Of the 3140 US counties, only 282 (8.98%) appeared to advance White-Black equity in optimal births, and 205 (6.53%) appeared to advance White-Hispanic equity in optimal births. In the effort improve maternal health, we should focus not only on the absence of negative outcomes, but also the occurrence of positive outcomes. Our analytic results suggest that optimal births can be measured and that geographic inequities by race occur.

Translation and Validation of the Mongolian Version of the Childbirth Experience Questionnaire

Women's experiences of childbirth have a significant impact on mother and child health and well-being as well as quality of care. A valid and reliable tool is needed to assess women's experience. This study aim was to adapt the Childbirth Experience Questionnaire to the Mongolian context and assess its psychometric properties. The study conducted between October and January 2019 at the public maternity hospital in Ulaanbaatar by recruiting a total of 828 low-risk postpartum women. The response rate was 92% (n = 761). Confirmatory factor analysis indicated a good fit for the 4-factor model. Reliability was good for the overall instrument (Cronbach's alpha = 0.83) and for individual domains (Cronbach's alphas ranging from 0.45 to 0.80). The overall and domain scores were significantly higher among women who had previous birth experience, who did not receive oxytocin augmentation, and who experienced a shorter labor duration (<12 h).The Mongolian version of the Childbirth Experience Questionnaire is a valid and reliable tool for exploring the childbirth experience. It can be used to promote women-centered, respectful care in maternity hospitals.

Women's agenda for the improvement of childbirth care: Evaluation of the Babies Born Better survey data set in Spain

BACKGROUND

Public patient involvement (PPI) generates knowledge about the health-illness process through the incorporation of people's experiences and priorities. The Babies Born Better (BBB) survey is a pan-European online questionnaire that can be used as a PPI tool for preliminary and consultative forms of citizens' involvement. The purpose of this research was to identify which practices support positive birth experiences and which ones women want changed.

METHODS

The BBB survey was distributed in virtual communities of practice and through social networks. The version launched in Spain was used to collect data in 2014 and 2015 from women who had given birth in the previous 5 years. A descriptive, quantitative analysis was applied to the sociodemographic data. Two open-ended questions were analyzed by qualitative content analysis using a deductive and inductive codification process.

RESULTS

A total of 2841 women participated. 41.1% of the responses concerned the category "Care received and experienced," followed by "Specific interventions and procedures" (26.6%), "Involved members of care team" (14.2%), and "Environmental conditions" (9%). Best practices were related to how care is provided and received, and the main areas for improvement referred to specific interventions and procedures.

CONCLUSIONS

This survey proved a useful tool to map the best and poorest practices reported. The results suggest a need for improvement in some areas of childbirth care. Women's reports on negative experiences included a wide range of routine clinical interventions, avoidable procedures, and the influence exerted by professionals on their decision-making.

Band of mothers: Childbirth as a female bonding experience

Does the experience of childbirth create social bonds among first-time mothers? Previous research suggests that sharing emotionally intense or painful experiences with others leads to “identity fusion,” a visceral feeling of oneness with a group that predicts strong forms of prosocial action and self-sacrifice for other group members. This study compared identity fusion with other mothers during pregnancy versus after childbirth in a sample of 164 U.S. women. Eighty-nine mothers in our sample were pregnant with their firstborn, and 75 mothers had given birth to their firstborn up to 6 months prior to the time of data collection. Results demonstrated that identity fusion with other mothers was higher for postpartum mothers than for antenatal mothers. As predicted, among postpartum mothers, those who thought that their childbirth was more painful than a typical childbirth experience reported greater identity fusion with mothers who reported having had a very difficult birth. Postpartum mothers’ ruminative thought about the birth mediated the association between level of dysphoria and identity fusion, and identity fusion moderated the association between postpartum mothers’ ruminative and reflective thought about the birth and their posttraumatic growth in complex ways. These findings provide evidence that perceived sharedness of the childbirth experience and thoughts about the birth are important to the process of identity fusion with other mothers, and highlight the importance of post-event processing for psychological health.

Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two-year cohort study

Background

Poor maternal childbirth experience plays a role in family planning and subsequent pregnancies. The aim of this study was to compare childbirth experiences in induced and spontaneous labor and to investigate the factors influencing the childbirth experience.

Methods

This two-year cohort study included all women with term singleton pregnancies in cephalic presentation aiming for vaginal delivery at Helsinki University Hospital between January 2017 and December 2018. Maternal satisfaction in the childbirth experience was measured after delivery using a Visual Analog Scale (VAS) score. A low childbirth experience score was defined as VAS < 5. The characteristics and delivery outcomes of the study population were collected in the hospital database and analyzed by SPSS.

Results

A total of 18,396 deliveries were included in the study, of which 28.9% (n = 5322) were induced and 71.1% (n = 13 074) were of spontaneous onset. The total caesarean delivery rate was 9.3% (n = 1727). Overall, 4.5% (n = 819) of the women had a low childbirth experience VAS score. The women who underwent labor induction were less satisfied with their birth experience compared to women with spontaneous onset of labor [7.5% (n = 399) vs. 3.2% (n = 420); p < 0.001]. Poor childbirth experience was associated with primiparity [OR 2.0 (95% CI 1.6–2.4)], labor induction [OR 1.6 (95% CI 1.4–1.9)], caesarean delivery [OR 4.5 (95% CI 3.7–5.5)], operative vaginal delivery [OR 3.3 (95% CI 2.7-4.0)], post-partum hemorrhage [OR 1.3 (95% CI 1.1–1.6)], and maternal infections [OR 1.7 (95% CI 1.3–2.4)].

Conclusions

Poor childbirth experience was associated with labor induction, primiparity, operative delivery, and labor complications, such as post-partum hemorrhage and maternal infections. These results highlight the aspects of care for which patient experience may be improved by additional support and counselling.

A qualitative insight into the relationship between postpartum depression and body image

Objective: This study qualitatively explored the experience of depression and body image concerns in women diagnosed with depression in the postpartum period.Background: Women's bodies undergo substantial changes during the perinatal period which can impact their body image and mood post-birth.However, it remains unknown how women diagnosed with depression experience their body image in the postpartum period.Methods: Seventeen women in their firstpostpartumyear completed qualitative telephone interviews: seven women diagnosed with depression and ten without depression. Thematic content analysis identified the main themes of the women's narratives: 1) expectations and adjustments to motherhood; 2) mood in response to changing postpartum body; 3) the context of feeling bad about my body; and 4) body letting me down and relationship to mood.Results: Differences in the relationship between body image and mood for postpartum women with depression compared to women without depression were revealed. Other themes seemed to be experienced in the same way by women with and without depression.Conclusion: Poor body image and depressive symptoms appear linked during postpartum. An improved understanding of this association may assist postpartum women to manage negative body image post-birthand prevent the exacerbation of negative emotional health in this period.

Improving the Experience of Care: Results of the American Association of Birth Centers Strong Start Client Experience of Care Registry Pilot Program, 2015-2016

In 2018, the Center for Medicare and Medicaid Innovation in the United States (US) released report demonstrating birth centers as the appropriate level of care for most Medicaid beneficiaries. A pilot project conducted at 34 American Association of Birth Centers (AABC) Strong Start sites included 553 beneficiaries between 2015 and 2016 to explore client perceptions of high impact components of care. Participants used the AABC client experience of care registry to report knowledge, values, and experiences of care. Data were linked to more than 300 process and outcome measures within the AABC Perinatal Data Registry™. Descriptive statistics, t tests, χ analysis, and analysis of variance were conducted. Participants demonstrated high engagement with care and trust in pregnancy, birth, and parenting. Beneficiaries achieved their preference for vaginal birth (89.9%) and breastfeeding at discharge through 6 weeks postpartum (91.7% and 87.6%). Beneficiaries reported having time for questions, felt listened to, spoken to in a way they understood, being involved in decision making, and treated with respect. There were no variations in experience of care, cesarean birth, or breastfeeding by race. Medicaid beneficiaries receiving prenatal care at AABC Strong Start sites demonstrated high levels of desired engagement and reported receiving respectful, accessible care and high-quality outcomes. More investment and research using client-reported data registries are warranted as the US works to improve the experience of perinatal care nationwide.

Women's experiences of maternity care in England: preliminary development of a standard measure

BACKGROUND

As maternity services evolve and the population of women served also changes, there is a continuing need to effectively document the views of women with recent experience of care. A woman's maternity experience can have a positive or negative effect upon her emotional well-being and health, in the immediate and the long-term, which can also impact the infant and the wider family system. Measuring women's perceptions of maternity services is an important way of monitoring the quality of care provision, as well as providing key indicators to organisations of the services that they are providing. It follows that, without information identifying possible areas in need of improvement, it is not clear what changes should be made to improve the experiences of women during their journey through maternity services from pregnancy to the early weeks at home with a new baby . The objective is to describe the development process and psychometric properties of a measure of women's experience of maternity care covering the three distinctly different phases of maternity - pregnancy, labour and birth, and the early postnatal period.

METHODS

Data from a national survey of women who had recently given birth (n = 504) were used. Exploratory and confirmatory factor analytic methods were employed. The measure was assessed for underlying latent factor structure, as well as for reliability, internal consistency, and validity (predictive, convergent and discriminant).

RESULTS

The models developed confirmed the use of three separate, but related scales about experience of maternity care during pregnancy, labour and birth and the postnatal period. Data reduction was effective, resulting in a measure with 36 items (12 per scale).

CONCLUSION

The need for a psychometrically robust and qualitatively comprehensive measure of women's experience of maternity care has been addressed in the development and validation of this prototype measure. The whole measure can be used at one time point, or the three separate subscales used as individual measures of experience during particular phases of the maternity journey with identified factor structures in their own right.

Comparing the Effects of Progressive Muscle Relaxation and Physical Activity on Pregnant Women's General Health

Background:

Pregnancy is important because maternal health and well-being directly affects another person's life. This study aimed to compare the effects of progressive muscle relaxation (PMR) and physical activity (PA) on the general health of pregnant women.

Materials and Methods:

This randomized clinical trial was conducted among 96 primiparous women enrolled in a prenatal clinic in Tehran (Iran) between May 3, 2013 and August 7, 2013. The participants were selected through convenience sampling over 3 weeks and randomly assigned to the PMR, PA, and control groups, comprising 32 participants each. Six participants did not complete the follow-up measurement (N = 90). The PMR group underwent three sessions of 1.5–2 h in theoretical and practical training, and in the PMR group, training was given in groups of three to four persons. Both groups performed exercises at home for 8 weeks and recorded them in daily report sheets. The general health of all three groups was assessed before and after intervention by using the General Health Questionnaire-28.

Results:

Differences in the mean (SD) general health scores obtained before and after intervention in the PMR, PA, and control groups were 15.63 (5.73), 19.11 (7.79), and 8.27 (2.14), respectively. One-way analysis of variance test showed a significant difference between the three groups (F = 28.10; p < 0.001).

Conclusions:

As the study results confirm the positive effects of PMR and PA on the subscales of the general health of pregnant women, the two techniques are recommended to promote the general health of pregnant women.

The Effectiveness of Hypnosis Intervention for Labor: An Experimental Study

Hypnosis has been shown to help pregnant women experience improved labor and postpartum periods. The present study compares the differences between experimental (n = 23) and control groups (n = 22) on specific variables measured both during labor and 24 hr postpartum. The participants in the experimental group received the hypnosis intervention at weeks 16, 20, 28, and 36 of pregnancy, while those in the control group received only routine antenatal care. The data collected at the labor stage describe the length of the labor stage, pain relief used during labor, the method of delivery, and the type of assisted vaginal delivery. Within 24 hr of delivery, data on neonatal birth weight, neonatal Apgar scores, and self-reported pain were obtained. The labor stage results showed no significant differences in the length of the second and third stages of labor. Although the participants in the experimental group reported higher pain levels immediately prior to, during, and immediately after delivery, their use of pethidine during labor was significantly lower than the control group participants. None of the experimental group participants opted for an epidural, and they had a greater number of assisted vaginal deliveries than the control group participants. The 24 hr postpartum results showed that the neonates of the experimental group participants had nonsignificantly higher Apgar scores than those of the women in the control group. Group differences in neonatal weight were not significant. The results of the present study indicate that hypnosis is useful for assisting pregnant women during labor and the postpartum period.

Client-Related Factors Associated with a "Less than Good" Experience of Midwifery Care during Childbirth in the Netherlands

BACKGROUND

A "less than good" experience during childbirth can affect a mother's early interaction with her child and may significantly influence a woman's emotional well-being. In this study, we focus on clients who experienced midwifery care provided during childbirth as "less than good" care. The aim of this study was to understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve this care.

METHODS

This study was part of the "DELIVER study" where mothers report on the care they received. We used generalized estimation equations to control for correlations within midwife practices. Forward multivariate logistic regression analyses were conducted to model the client-related factors associated with the experienced midwifery care during childbirth.

RESULTS

We included the responses of 2,377 women. In the multivariable logistic regression model, odds of reporting "less than good care" were significantly higher for women who experienced an unplanned cesarean birth (OR 2.21 [CI 1.19-4.09]), an instrumental birth (OR 1.55 [CI 1.08-2.23]), and less control during the dilation phase (OR 0.98 [CI 0.97-0.99]) and pushing phase (OR 0.98 [CI 0.97-0.99]).

DISCUSSION

Birth-related factors were more likely than maternal characteristics to be associated with the experience of midwifery care during childbirth. We conclude that there is room for midwives to improve their care for women during childbirth particularly in improving the patient centeredness of the care provider, using strategies to enhance sense of control, and focusing on the particular needs of those who experience instrumental vaginal or unplanned cesarean births.

Support for mothers and their families after life-threatening illness in pregnancy and childbirth: a qualitative study in primary care

BACKGROUND

One in 100 women who give birth in the UK develop life-threatening illnesses during childbirth. Without urgent medical attention these illnesses could lead to the mother's death. Little is known about how the experience of severe illness in childbirth affects the mother, baby, and family.

AIM

As part of the UK National Maternal Near-miss Surveillance Programme, this study explored the experiences of women and their partners of life-threatening illnesses in childbirth, to identify the long-term impact on women and their families.

DESIGN AND SETTING

Qualitative study based on semi-structured narrative interviews. Interviews were conducted in patients' homes in England and Scotland from 2010 to 2014.

METHOD

An in-depth interview study was conducted with 36 women and 11 partners. A maximum variation sample was sought and interviews transcribed for thematic analysis with constant comparison.

RESULTS

Women's birth-related illnesses often had long-lasting effects on their mental as well as physical health, including anxiety, panic attacks, and post-traumatic stress disorder. In some cases the partner's mental health was also affected. Women often described feeling isolated. Their experiences can have a profound impact on their relationships, family life, career, and future fertility. While some women described receiving good support from their GP, others felt there was little support available for them or their families after discharge from hospital.

CONCLUSION

A near-miss event can have long-lasting and major effects on women and their families. Support in primary care, including watchful waiting for mental health impacts, can play a valuable role in helping these families come to terms with their emergency experience. The findings highlight the importance of communication between primary and secondary care.

The Spanish version of the Childbirth Experience Questionnaire (CEQ-E): reliability and validity assessment

BACKGROUND

The Childbirth Experience Questionnaire (CEQ) was originally designed to study women's perceptions of labour and birth. The main objective of our study was to adapt the CEQ to the Spanish context and determine its psychometric properties. This would provide an opportunity to evaluate women's experiences in order to improve evidence in the Spanish context as recommended by national guidelines.

METHODS

The CEQ was translated into Spanish using a standard forward and back translation method (CEQ-E). A convenience sample of 364 women was recruited from 3 Spanish hospitals; all participants were able to read and write in Spanish. Mothers with high risk pregnancies or preterm deliveries were excluded from the study. A self-administered questionnaire on sociodemographic variables was completed by participants before discharge. Data on childbirth variables were obtained from maternity records. Between 1 and 3 months postpartum a postal CEQ-E questionnaire was sent. The CEQ-E structure was examined by a confirmatory factor analysis of polychoric correlations using a diagonally weighted least squares estimator. Reliability was assessed using Cronbach's alpha. Construct validity was conducted by testing differences in CEQ-E scores between known-groups (to differ on key variables).

RESULTS

226 (62.1%) of the recruited participants completed the postal questionnaire. The CEQ-E factor structure was similar to the original one. The Spanish version showed fit statistics in line with standard recommendations: CFI = 0.97; NNFI = 0.97; RMSEA = 0.066; SRMS = 0.077. The internal consistency reliability of the CEQ-E was good for the overall scale (0.88) and for all subscales (0.80, 0.90, 0.76, 0.68 for "own capacity", "professional support", "perceived safety" and "participation", respectively) and similar to the original version. Women with a labour duration ≤ 12 h, women with a labour not induced, women with a normal birth and multiparous women showed higher overall CEQ-E scores and "perceived safety" subscale scores. Women with a labour duration ≤ 12 h and those with previous experience of labour obtained higher scores for the "own capacity" and "participation" subscales.

CONCLUSIONS

The results of this study indicate that the CEQ-E can be considered a valid and reliable measure of women's perceptions of labour and birth in Spain.

Self-reported pregnancy-related health problems and self-rated health status in Rwandan women postpartum: a population-based cross-sectional study

Background

Self-rated health status (SRH) can be used as a predictor of morbidity and mortality. Postpartum self-rated health has been used to estimate maternal morbidity and postpartum problems. Reproductive history factors are associated with poor self-rated health postpartum. This study investigated prevalence of self-reported health problems during first, second, and third trimesters of pregnancy, delivery, and postpartum. In addition, this study investigated SRH in Rwandan women up to 13 months from partus.

Methods

This population-based, cross-sectional study collected data in 2014 using structured interviews (N = 921). Univariable analysis was used to identify variables that were associated with poor self-rated health status (poor-SRH). Logistic regression analyses were performed to identify factors associated with poor-SRH at one day, one week, and one month postpartum and at the time of the interview.

Results

Mean time between latest delivery and the time of interview was 7.1 months. Prevalence of anaemia, hypertension, diabetes mellitus during pregnancy, and severe bleeding during pregnancy and labour were 15.0, 4.9, 2.4, and 3.7 %, respectively. The prevalence of poor-SRH was 32.2 % at one day postpartum, 7.8 % at one month, and 11.7 % at time of the interview. Hypertension during pregnancy and significant postpartum haemorrhage were associated with poor-SRH at one day and one week postpartum. Severe bleeding during pregnancy and labour were associated with poor-SRH at one week and one month postpartum. Infection and anaemia during pregnancy were associated with poor-SRH at one month postpartum and at the time of interview. The Kaplan-Meier curves illustrate restitution of health for most women during the study period.

Conclusions

This population-based study reports a high prevalence of poor SRH status among Rwandan women in the early postpartum period. Identified factors associated with poor-SRH were severe bleeding, hypertension, infection, and anaemia during pregnancy and postpartum haemorrhage. These factors may be prevented or reduced by providing more frequent and specific attention during pregnancy and by providing timely measures that address complications during delivery, including adequate postpartum care.

Influences on vaginal birth after caesarean section: A qualitative study of Taiwanese women

BACKGROUND

Vaginal birth is a safe mode of birth for most women who have had a prior caesarean with a transverse incision. Despite the evidence, most Taiwanese women who have had a previous caesarean are rarely offered the opportunity to consider any possibility other than a repeat caesarean.

AIM

This study explored factors affecting Taiwanese women's decisionmaking regarding vaginal birth after cesarean.

METHODS

Ajzen's Theory of Planned Behaviour provided the theoretical framework to underpin the study, which adopted an interpretive descriptive methodology. Sequential semi-structured interviews were conducted with 29 women who had a previous caesarean and were pregnant between 34 and 38 weeks gestation, ten women who attempted vaginal birth in the third to fifth day postpartum, and 25 women in the fourth week postpartum. Boyatzis' method of thematic analysis was used to identify themes and codes.

FINDINGS

This paper reports the findings of the prenatal interviews with 29 participants. The major factor influencing women's decision-making was to avoid negative outcomes for themselves and their babies. Three thematic codes describe influences on the women's decisions: 'past experience of childbirth', 'anticipating the next experience of normal birth' and 'contemplation on the process of childbirth'.

CONCLUSIONS

Women who have had a previous caesarean section are prepared to have a vaginal birth but are not always supported to carry out this decision. Changing the models of antenatal care is recommended as a strategy to overcome this difficulty therefore empowering women to make a meaningful choice about VBAC after a CS.

Baby Steps - An Online Program Promoting the Well-Being of New Mothers and Fathers: A Study Protocol

BACKGROUND

Parental well-being can be seriously impacted during the challenging perinatal period. Most research and support services focus on perinatal psychopathology, leaving a need for programs that recognize and enhance the strengths and well-being of parents. Furthermore, fathers have received minimal attention and support relative to mothers, despite experiencing perinatal distress. New parents have limited time and energy to invest in program attendance, and web-based programs provide an ideal platform for delivering perinatal well-being programs. Such programs are globally accessible, available at any time, and can be accessed anywhere with an Internet connection.

OBJECTIVE

This paper describes the protocol of a randomized controlled trial investigating the effects on first-time parents' perinatal well-being, comparing two versions of the online program Baby Steps.

METHODS

The clinical trial will randomize 240 primiparous mother-father couples to either (1) Babycare, an online information-only program providing tips on selected childcare issues, or (2) Well-being, an online interactive program including all content from the Babycare program, plus parental well-being-focused content with tools for goal-setting and problem solving. Both programs will be supported by short message service (SMS) texts at two, four, seven, and ten weeks to encourage continued use of the program. Primary outcomes will be measures of perinatal distress and quality of life. Secondary outcomes will be couple relationship satisfaction, parent self-efficacy, and social support. Cost-effectiveness will also be measured for each Baby Steps program.

RESULTS

Participant recruitment commenced March, 2015 and continued until October, 2015. Follow-up data collection has commenced and will be completed May, 2016 with results expected in July, 2016.

CONCLUSIONS

Perinatal distress has substantial impacts on parents and their infants, with potential to affect later childhood adjustment, relationships, and development. This study aims to test the impact of a highly accessible online program to support parental coping, and maximize the well-being of both parents. By including fathers in the program, Baby Steps has the potential to engage and support this often neglected group who can make a substantial contribution to familial well-being.

CLINICALTRIAL

Australian & New Zealand Clinical Trials Registry: ANZCTR12614001256662; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367277 (Archived by WebCite at http://www.webcitation.org/6ibUsjFIL).

Beyond maternal death: improving the quality of maternal care through national studies of ‘near-miss’ maternal morbidity

Background

Studies of maternal mortality have been shown to result in important improvements to women’s health. It is now recognised that in countries such as the UK, where maternal deaths are rare, the study of near-miss severe maternal morbidity provides additional information to aid disease prevention, treatment and service provision.

Objectives

To (1) estimate the incidence of specific near-miss morbidities; (2) assess the contribution of existing risk factors to incidence; (3) describe different interventions and their impact on outcomes and costs; (4) identify any groups in which outcomes differ; (5) investigate factors associated with maternal death; (6) compare an external confidential enquiry or a local review approach for investigating quality of care for affected women; and (7) assess the longer-term impacts.

Methods

Mixed quantitative and qualitative methods including primary national observational studies, database analyses, surveys and case studies overseen by a user advisory group.

Setting

Maternity units in all four countries of the UK.

Participants

Women with near-miss maternal morbidities, their partners and comparison women without severe morbidity.

Main outcome measures

The incidence, risk factors, management and outcomes of uterine rupture, placenta accreta, haemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, severe sepsis, amniotic fluid embolism and pregnancy at advanced maternal age (≥ 48 years at completion of pregnancy); factors associated with progression from severe morbidity to death; associations between severe maternal morbidity and ethnicity and socioeconomic status; lessons for care identified by local and external review; economic evaluation of interventions for management of postpartum haemorrhage (PPH); women’s experiences of near-miss maternal morbidity; long-term outcomes; and models of maternity care commissioned through experience-led and standard approaches.

Results

Women and their partners reported long-term impacts of near-miss maternal morbidities on their physical and mental health. Older maternal age and caesarean delivery are associated with severe maternal morbidity in both current and future pregnancies. Antibiotic prescription for pregnant or postpartum women with suspected infection does not necessarily prevent progression to severe sepsis, which may be rapidly progressive. Delay in delivery, of up to 48 hours, may be safely undertaken in women with HELLP syndrome in whom there is no fetal compromise. Uterine compression sutures are a cost-effective second-line therapy for PPH. Medical comorbidities are associated with a fivefold increase in the odds of maternal death from direct pregnancy complications. External reviews identified more specific clinical messages for care than local reviews. Experience-led commissioning may be used as a way to commission maternity services.

Limitations

This programme used observational studies, some with limited sample size, and the possibility of uncontrolled confounding cannot be excluded.

Conclusions

Implementation of the findings of this research could prevent both future severe pregnancy complications as well as improving the outcome of pregnancy for women. One of the clearest findings relates to the population of women with other medical and mental health problems in pregnancy and their risk of severe morbidity. Further research into models of pre-pregnancy, pregnancy and postnatal care is clearly needed.

Funding

The National Institute for Health Research Programme Grants for Applied Research programme.

The birth experience and women's postnatal depression: A systematic review

BACKGROUND

maternal postnatal depression confers strong risk for impaired child development. Little is known about the association between women's postnatal birth experience and postnatal depression.

PURPOSE

to systematically identify and review studies examining the association between the birth experience and postnatal depression.

METHODS

a systematic search strategy was employed using the Matrix Method (Garrard, 2014) and guided by the PRISMA reporting process.Criteria included broad search terms, English language, and publication years 2000-2015. The search revealed 1536 abstracts narrowed to full-text review of 112 studies.

FINDINGS

eleven of the 15 studies meeting search criteria demonstrated a significant association between women's postnatal birth experience and postnatal depression. Results show heterogeneity in birth experience instruments. Strength of evidence and potential for bias are discussed.

KEY CONCLUSIONS

in spite of methodological limitations, the weight of evidence suggests that a negative birth experience may contribute to postnatal depression. Further research is warranted.

IMPLICATIONS FOR PRACTICE

to promote a positive birth experience healthcare providers should provide supportive, nurturing care that promotes women's confidence, trust, respect, privacy, shared decision making, and feeling of safety. Healthcare policy that promotes quality caregiving may reduce risk of postnatal depression.

Gaining insight into how women conceptualize satisfaction: Western Australian women's perception of their maternity care experiences

Background

The concept of maternal satisfaction is challenging, as women’s and clinicians’ expectations and experiences can differ. Our aim was to investigate women’s experiences of maternity care in an urban tertiary obstetric setting, to gain insight into conceptualization of satisfaction across the childbirth continuum.

Methods

This mixed method study was conducted at a public maternity hospital in Western Australia. A questionnaire was sent to 733 women two weeks post birth, which included an invitation for an audio-recorded, telephone interview. Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis of interview transcripts was undertaken to extract common themes.

Results

A total of 54 % (399 of 733) returned the questionnaire. Quantitative results indicated that women were less likely to feel: involved if they did not have a spontaneous vaginal birth (P = 0.020); supported by a midwife if they had a caesarean (P = <0.001); or supported by an obstetrician if they had a spontaneous vaginal birth (P = <0.001).

Qualitative findings emerged from 63 interviews which highlighted the influence that organization of care, resources and facilities had on women’s satisfaction. These paradigms unfolded as three broad themes constructed by four sub-themes, each illustrating a dichotomy of experiences. The first theme ‘how care was provided’ encompassed: familiar faces versus a different one every time and the best place to be as opposed to so disappointed. The second theme ‘attributes of staff’ included: above and beyond versus caring without caring and in good hands as opposed to handled incorrectly. The third theme ‘engaged in care’ incorporated: explained everything versus did not know why and had a choice as opposed to did not listen to my needs.

Conclusions

Quantitative analysis confirmed that the majority of women surveyed were satisfied. Mode of birth influenced women’s perception of being involved with their birth. Being able to explore the diversity of women’s experiences in relation to satisfaction with their maternity care in an urban, tertiary obstetric setting has offered greater insight into what women value: a sensitive, respectful, shared relationship with competent clinicians who recognise and strive to provide woman focused care across the childbirth continuum.

The effect of progressive muscle relaxation on pregnant women's general health

Background:

Pregnancy may be accompanied by serious physiological and psychological changes as it is a stressful period in a woman's life. So, this study was conducted to determine the effect of progressive muscle relaxation on pregnant women's general health.

Materials and Methods:

In this clinical trial, 60 primigravida women admitted to the prenatal clinic of selected hospitals in Iran constituted the study population. Using purposive sampling method, the level of general health of the women was measured with General Health Questionnaire-28 (GHQ-28). Then, the samples were randomly divided into control and experimental groups. Three 1.5–2 h relaxation training sessions were held for the experimental group. After 8 weeks, the level of general health of both groups was measured again. Finally, the collected data were analyzed using Chi-square and paired t-test (P < 0.05).

Results:

Total mean score of general health of the experimental group and the control group before the intervention was 35.83 (6.92) and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and 27.85 (8.24). Although after the intervention both groups showed an increased level of general health, the difference in general health between before and after intervention was significant in the experimental group (P < 0.001). Furthermore, comparison of variations in mean scores of general health level before and after intervention in the two groups showed a significant difference (P < 0.001).

Conclusions:

Given that the results showed the effectiveness of progressive muscle relaxation on pregnant women's general health, the prenatal clinics can include a training program for progressive muscle relaxation in the routine training programs for pregnant women.

Risk of psychological distress in parents of preterm children in the first year: evidence from the UK Millennium Cohort Study

OBJECTIVE

To assess whether the parents of babies born preterm (PT; <37 weeks completed gestation) are at excess risk of psychological distress (PD) at 9 months postpartum, and to explore the influence of the degree of prematurity.

DESIGN AND PARTICIPANTS

Data were drawn from the UK Millennium Cohort Study, a nationally representative prospective cohort of babies born in 2000-2002. 12,100 families with complete data available for both parents at recruitment (9 months postpartum) are included.

EXPOSURE AND OUTCOME

Mothers report of gestational age at birth (in weeks) was grouped into: very PT (<32 weeks), moderately PT (32-33 weeks), late PT (34-36 weeks), early term (37-38 weeks), full-term (39-41 weeks), post-term (42 weeks). PD was assessed using a modified Rutter Malaise Inventory, a validated instrument that has been used in both men and women to assess levels of anxiety and distress.

RESULTS

Overall, 7% of families reported a PT birth; 12.1% of mothers and 8.9% of fathers showed signs of PD at 9 months postpartum. The mothers of very PT infants had an increased risk of PD, compared with the mothers of full-term babies (unadjusted OR 2.10 (1.30 to 3.39; adjusted OR 1.66 (1.02 to 2.69)). Mothers of moderate or late PT babies had no apparent increased risk of PD. However, mothers of early term babies also showed a small excess risk of PD (adjusted OR 1.16 (0.99 to 1.36)). Unadjusted analysis suggested a doubling in the risk of PD in fathers of very and moderately PT babies, compared with fathers of full-term babies, which remains statistically significant after adjustment in the moderately PT group (adjusted OR1.98 (1.20 to 3.29)).

CONCLUSIONS

The parents of very PT children are at an increased risk of PD at 9 months postpartum, and mothers of children born at early term also see an elevated risk compared with mothers of full-term babies.

Smoothing out the transition of care between maternity and child and family health services: perspectives of child and family health nurses and midwives'

BACKGROUND

In Australia, women who give birth are transitioned from maternity services to child and health services once their baby is born. This horizontal integration of services is known as Transition of Care (ToC). Little is known of the scope and processes of ToC for new mothers and the most effective way to provide continuity of services. The aim of this paper is to explore and describe the ToC between maternity services to CFH services from the perspective of Australian midwives and child and family health (CFH) nurses.

METHOD

This paper reports findings from phase two of a three phase mixed methods study investigating the feasibility of implementing a national approach to CFH services in Australia (the CHoRUS study). Data were collected through a national survey of midwives (n = 655) and CFH nurses (n = 1098). Issues specifically related to ToC between maternity services and CFH services were examined using descriptive statistics and content analysis of qualitative responses.

RESULTS

Respondents described the ToC between maternity services and CFH services as problematic. Key problems identified included communication between professionals and services and transfer of client information. Issues related to staff shortages, early maternity discharge, limited interface between private and public health systems and tension around role boundaries were also reported. Midwives and CFH nurses emphasised that these issues were more difficult for families with identified social and emotional health concerns. Strategies identified by respondents to improve ToC included improving electronic transfer of information, regular meetings between maternity and CFH services, and establishment of liaison roles.

CONCLUSION

Significant problems exist around the ToC for all families but particularly for families with identified risks. Improved ToC will require substantial changes in information transfer processes and in the professional relationships which currently exist between maternity and CFH services.

Staying Involved “Because the Need Seems So Huge”: Midwives Working With Women Living in Areas of High Deprivation

The aim of this research was to answer the research question “what is the midwifery care provided by midwives to women living in areas of high deprivation?” It has been identified that rates of stillbirth and neonatal death are significantly higher in women living in the most socioeconomically deprived areas of New Zealand. A potential contributory factor to these rates is the issue of access to, and engagement with, maternity services. Yet, little is known about the care midwives provide to women living in areas of socioeconomic deprivation.

Using grounded theory methodology, a conceptual framework was developed from data analysis of 8 interviews undertaken with midwives between August 2000 and March 2001. Findings revealed a core category of “staying involved `because the need seems so huge.”’ Four further categories were identified: “Forming relationships with the wary,” “Giving `an awful lot of support,”’ “Remaining close by,” and “Ensuring personal coping.” Throughout, the midwives’ continued involvement with the woman ensured an optimal pregnancy outcome for both the woman and her new baby.

The findings from this study inform the care provided by midwives who work with women living in areas of high deprivation and begin to address factors regarding access to, and engagement with, maternity services.