The Association of Maternal Satisfaction with Childbirth by Length of Second Stage

OBJECTIVE

The aim of this study was to quantify patient satisfaction by hour of second stage of labor and subsequent delivery mode.

STUDY DESIGN

Pilot cross-sectional study of nulliparous women delivered at George Washington University Hospital between April 2018 and March 2019. Patients completed three survey questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), and Six Simple Questions (SSQ). Length of second stage was divided into 2 groups (≤3 hours and >3 hours). Data on maternal characteristics, maternal outcomes, and neonatal outcomes were collected in REDCap and statistical analysis was performed using SAS version 9.4.

RESULTS

Survey response rate was 100% (n = 100). Seventy-one patients had a normal second stage and 29 patients had a prolonged second stage. Prolonged second stage was significantly associated with a lower proportion of NSVD (65.5 vs. 90.1%; p <0.01) and a higher proportion of epidural (82.8 vs. 60.6%; p = 0.03) in comparison to a normal second stage. Length of second stage had a statistically significant negative correlation with overall PPS scores (ρ =  - 0.25, p ≤0.01). Length of second stage was not correlated with the SSQ (ρ = 0.05, p = 0.25) or CSQ (ρ =  - 0.18, p = 0.11) surveys. CSQ scores were statistically significantly lower in women who underwent second stage cesarean delivery.

CONCLUSION

Maternal satisfaction with childbirth and health care experience was high regardless of length of second stage. Only the PSS survey showed that shorter length of second stage was correlated with higher satisfaction. Cesarean delivery in the second stage was significantly associated with decreased maternal satisfaction. Future studies with larger cohorts are needed to confirm our findings.

KEY POINTS

· There is limited data on maternal satisfaction with childbirth.. · Mode of delivery may affect maternal satisfaction.. · Shared decision-making about delivery mode and timing is crucial..

The effect of interventions in vaginal birth on fear of childbirth: A multicentre study

AIM

This cross-sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth.

METHODS

In this cross-sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B.

RESULTS

The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow-ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow-up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth.

CONCLUSIONS

The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth.

Autonomy in labour and delivery in a Latin American urban centre: a qualitative phenomenological analysis

The medicalisation of childbirth has diminished the role of labouring people. We conducted an exploratory phenomenological qualitative study, using purposive sampling, and then conducted 17 semi-structured interviews between December 2016 and October 2017 with people who had recently given birth in a public hospital in the Northern Metropolitan area of Santiago, Chile. The sufficiency of the study group was determined according to saturation criteria. Triangulated content analysis was applied to explore the clinical relationship and processes of autonomy and decision-making. The predominant clinical relationship observed was paternalism. The participation of labouring people in decision-making is scarce, with no evidence of ethically valid processes of informed consent.

The effect of mindfulness-based counseling on the childbirth experience of primiparous women: a randomized controlled clinical trial

INTRODUCTION

Unpleasant childbirth experience is considered as one of the important factors for cesarean preference. Limited studies have been investigated the impact of psycho-based interventions on the childbirth experience and the most effective counseling approach to promote a pleasant childbirth experience has not been clearly identified.

OBJECTIVE

The present study aimed to evaluate the impact of mindfulness-based counseling on the childbirth experience of primiparous women.

METHODS AND MATERIALS

This randomized controlled clinical trial was conducted on 64 primiparous with gestational age of 32 to 34 weeks referred to the perinatology clinic of Al-Zahra and Taleghani educational-treatment hospital, affiliated to Tabriz University of Medical sciences, Iran. Participants were randomly assigned into the intervention and control groups. The intervention group received eight mindfulness-based counseling sessions. The intensity of childbirth pain with VAS (Visual Analog Scale) in the active phase of labor at 8 cm dilatation and the childbirth experience questionnaire were completed by interview after childbirth. Independent t-test and ANCOVA were used to compare the outcomes between the two groups.

RESULTS

After controlling the effect of confounding variables, the mean score of childbirth experience in the intervention group was significantly higher than that in control group [Mean Difference (MD): 1.79, 95% CI: 2.52 to 1.07, P < 0.01]. The mean score of labor pain in the intervention group was significantly lower than that in the control group after controlling the effect of baseline score and confounding variables [MD: -2.21, 95% CL: -3.35 to -1.10, P < 0.001].

CONCLUSION

The findings indicated that providing mindfulness-based counseling improves the childbirth experience and reduces labor pain during childbirth. However, further randomized clinical trials are needed before making a definitive conclusion.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N9. Date of registration: 16/03/2022, 25/12/1400.

From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth

Women greatly value and benefit from the presence of someone they trust to support them throughout labour and childbirth ('labour companion of choice'). Labour companionship improves maternal and perinatal outcomes, including enhancing physiological labour and birth experiences. Despite clear benefits, implementation is slow. We conducted a scoping review to assess coverage and models of labour companionship, including quantitative studies reporting coverage of labour companionship in any level health facility globally. We searched MEDLINE, CINAHL, and Global Health from 1 January 2010-14 December 2021. We extracted data on study design, labour companionship coverage, timing and type of companions allowed, and recoded data into categories for comparison across studies. We included data from a maternal health sentinel network of hospitals in Latin America, using descriptive statistics to assess coverage among 120,581 women giving birth in these sites from April 2018-April 2022. In the scoping review, we included 77 studies from 27 countries. There was wide variation in the coverage of labour companionship: almost one-third of studies reported coverage less than 40%, and one-third of studies reported coverage between 40-80%. Husbands or partners were the most frequent companion (37.7%, 29/77), followed by family member or friend (gender not specified) (32.5%, 25/77), family member or friend (female-only) (13.0%, 10/77). Across nine sentinel hospitals in five Latin American countries, there was variation in coverage, with no companion at any time ranging from 14.9%-93.8%. Despite the well-known benefits and factors affecting implementation of labour companionship, more work is needed to improve equitable coverage. Concerted efforts are needed to engage with communities, health workers, health managers, and policy-makers to establish policies, address implementation barriers, and integrate data on coverage into perinatal records and quality processes to ensure that all women have access. Harmonized reporting of labour companionship would greatly enhance understanding at global level.

Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards

OBJECTIVE

To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland.

METHODS

Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables.

RESULTS

A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth.

CONCLUSION

Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

Prevalence of Compassion Fatigue and Its Association with Professional Identity in Junior College Nursing Interns: A Cross-Sectional Study

Background: The issue of compassion fatigue among clinical nurses has received considerable attention, particularly during the COVID-19 pandemic. Yet, the current status of compassion fatigue among junior college nursing interns remains unclear. Additionally, professional identity can modulate the impact of compassion fatigue or burnout on psychological well-being; however, whether professional identity still works in this group is also unclear. This study aimed to reveal the current status of compassion fatigue among nursing interns in junior colleges and also investigate the association between compassion fatigue and professional identity. Methods: This cross-sectional survey evaluated the levels of participants' compassion fatigue (The Compassion Fatigue Short Scale) and professional identity (Professional Identity Scale) in 2256 nursing interns. Results: The mean score of compassion fatigue was 44.99, and 19.5% of the participants scored above The Compassion Fatigue Short Scale median scores for compassion fatigue. A moderate negative correlation was detected between compassion fatigue and professional identity. Conclusions: The level of compassion fatigue among nursing interns is low but nearly one in five nursing students is at risk of compassion fatigue. More attention should be paid to nursing interns with a high risk of compassion fatigue. Future studies are warranted to explore which pathways could mediate the relationship between professional identify and comparison fatigue.

Maternal childbirth experience and time in labor: a population-based cohort study

A negative childbirth experience may have long term negative effects on maternal health. New international guidelines allow a slower progress of labor in the early active phase. However, a longer time in labor may influence the childbirth experience. In this population-based cohort study including 26,429 women, who gave birth from January 2016 to March 2020, the association between duration of different phases of active labor and childbirth experience was studied. The women assessed their childbirth experience by visual analogue scale (VAS) score. Data was obtained from electronic medical records. The prevalence of negative childbirth experience (VAS 1-3) was 4.9%. A significant association between longer duration of all labor phases and a negative childbirth experience was found for primi- and multipara. The adjusted odds ratio (aOR (95%CI)) of negative childbirth experience and longer time in active labor (above the 90th percentile) in primipara was 2.39 (1.98-2.90) and in multipara 2.23 (1.78-2.79). In primi-and multipara with duration of labor ≥ 12 h or ≥ 6 h the aOR (95%CI) of negative childbirth experience were 2.22 (1.91-2.58) and 1.91 (1.59-2.26) respectively. It is of great importance to identify and optimize the clinical care of women with longer time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.

The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial

The current study was aimed to evaluate the effects of interventions conducted in line with the coping with labor pain algorithm (holistic birth support strategies) on women's coping with labor pain, birth satisfaction, and fear of childbirth. The study is a single-center, parallel-group randomized, three-blind, controlled trial. The study was completed with 33 women in the experimental group and 31 in the control group. The mean score of the women in the experimental group from the Birth Satisfaction Scale (128.57 ± 5.83) was statistically significantly higher than that of the women in the control group (81.80 ± 7.73). The mean score of the women in the experimental group (61.96 ± 9.78) from the Wijma Birth Expectation/Experience Scale, Version B scale was statistically significantly lower than that of the women in the control group (148.64 ± 14.62). It was found that the women in the experimental group were able to better cope with labor pain, had higher birth satisfaction, and had less fear of childbirth.

Secondary traumatic stress among midwifery students

PURPOSE

This study aimed to examine the factors affecting secondary traumatic stress on midwifery students.

DESIGN AND METHODS

This descriptive study was conducted between November and December 2018. Data were collected using information form and the Secondary Traumatic Stress Scale.

FINDINGS

The study found that 22.2% of midwifery students met all the trauma criteria for posttraumatic stress disorder according to the Secondary Traumatic Stress Scale. Midwifery students who were unhappy to continue their education and those who wished to switch to another profession after graduation respectively showed a 2.8- and a 4-fold higher risk of meeting the trauma criteria (p < 0.05).

CONCLUSION

The secondary traumatic stress rate in midwifery students is particularly high considering the fact that one in five students fulfills all of the Secondary Traumatic Stress criteria. However, to reduce their secondary traumatic stress rate, students should be thoroughly assessed by the educators who could provide the support necessary.

IMPLICATIONS FOR NURSING PRACTICE

Before graduation from the midwifery departments, students traumatic stress symptoms could be assessed mental health nursing courses, which might enable to change their attitudes towards to cope with this situation. Especially after traumatic childbirths, midwifery students should be supported by mental health nurses to cope with traumatic stress. Midwifery students should be encouraged each and every possible moment to express their feelings when they experience traumatic stress and thus their skills for effective coping can be reinforced.

Women's satisfaction with childbirth and postpartum care and associated variables

OBJECTIVE

To determine the level of satisfaction with childbirth and the postpartum period.

METHOD

This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used.

RESULTS

A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001).

CONCLUSION

The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

Translation of the UK-Birth-Satisfaction-Scale-Revised (BSS-R) into Brazilian (Portuguese) and description of initial measurement properties

RATIONALE

The concept of birth satisfaction embraces many factors, which include for example perceived quality of care provision, stress experienced, and personal coping strategies. A woman's birth experience has the power to affect her mental health, decisions surrounding future birth planning, and quality of relationships with her partner and family. The UK-Birth-Satisfaction-Scale-Revised (UK-BSS-R) is currently recommended as the tool of choice by the International Consortium for Health Outcome Measures (ICHOM) for measuring women's experiences of childbirth. It was therefore considered important to translate and validate this scale for use in a Brazilian context.

OBJECTIVE

To translate and culturally adapt the UK-BSS-R into Brazilian (Portuguese) and validate its key measurement properties.

METHODS

A repeated-measures survey was conducted for the purpose of examining factor structure, validity and reliability of the Brazilian (Portuguese)-BSS-R.

PARTICIPANTS

Data was gathered from (n = 101) Brazilian Portuguese-speaking postnatal women.

RESULTS

The initial measurement characteristics of the Brazilian (Portuguese)-BSS-R in terms of Intraclass Correlational Coefficient, Standard Error of Measurement and minimal detectable change were found to be excellent.

CONCLUSION

The Brazilian (Portuguese)-BSS-R is now considered to be a valid and reliable multidimensional psychometric instrument for measuring birth satisfaction in a Brazilian Portuguese population of postnatal women. This translation was found to be conceptually consistent with the original English-language version (UK-BSS-R) and to have an excellent initial measurement characteristics profile. The direction of future research is indicated, specifically to undertake a thorough psychometric evaluation of the Brazilian (Portuguese)-BSS-R in a larger sample.

Validity and reliability of the Turkish version of the City Birth Trauma Scale (CityBiTS)

The City Birth Trauma Scale (CityBiTS) was developed to be consistent with the current Diagnostic and Statistical Manual of Mental Disorders-DSM-5. It has been used as a complementary instrument that measures the psychological trauma related to childbirth. The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. This research is a methodological study. This study was conducted with 315 women who had 6-month-old infants from August to October 2018. The CityBiTS is a 29-item instrument that was developed according to DSM-5 criteria to assess childbirth-related Post-Traumatic Stress Disorder. Test-retest measurements were performed at two-week intervals to evaluate the invariance of the scale over time. Cronbach's alpha coefficient of reliability was used to analyse internal consistency of scale. Cronbach's alpha coefficients were .76 for re-experiencing symptoms, .57 for avoidance symptoms, .77 for negative cognitions and mood, .83 for hyperarousal and .82 for dissociative symptoms. In conclusion, The Turkish version of the CityBiTS, as an instrument developed to be consistent with DSM-5 criteria in assessing childbirth-related trauma symptoms, is a valid and reliable tool.Impact statementWhat is already known on this subject? One of the possible barriers for this is the lack of validated questionnaires that measure the postpartum PTSD.What do the results of this study add? The aim of this study was to investigate the validity and reliability of the Turkish version of the CityBiTS. The City Birth Trauma Scale has good psychometric properties and the two symptom clusters identified are consistent with previous research on symptoms of postpartum PTSD.What are the implications of these findings for clinical practice and/or further research? The City Birth Trauma Scale provides with a measure of birth-related PTSD foruse in research and clinical practice.

Who benefits most from skin-to-skin mother-infant contact after birth? Survey findings on skin-to-skin and birth satisfaction by mode of birth

OBJECTIVE

Previous research has shown that skin-to-skin contact in the delivery room is associated with an increase satisfaction with childbirth. The purpose of the present study was to examine whether this association differs as a function of mode of birth, such that the positive effect of skin-to-skin contact would be especially pronounced for women who had operative births.

DESIGN

Survey design using self-administered questionnaires during pregnancy (Time 1) and at two months postpartum (Time 2).

SETTING

At Time 1, women were recruited at community and hospital medical centres in two large metropolitan areas in the centre of Israel and through home midwives and internet forums. At Time 2, women completed a second questionnaire in which they reported whether they had skin-to-skin contact with their infant immediately after birth and their birth satisfaction.

PARTICIPANTS

Pregnant women, gestation week ≥24, with singleton pregnancy, who took part in both T1 and T2 (N = 1371, 75% of the 1833 women recruited at T1).

MEASUREMENTS

Analysis of covariance (ANCOVA) was used to examine whether the association between skin-to-skin contact after birth and birth satisfaction two months post-partum, differs as a function of mode of birth. Maternal or infant complications during birth, parity, and whether the pregnancy was planned, served as covariates. Birth satisfaction was measured using the Childbirth Satisfaction Scale. All measures were self-reported.

FINDINGS

The frequency of skin-to-skin was high (83%) for women who had vaginal birth, but lower for women who had an instrumental birth (66%) or a caesarean section (31%). At two months postpartum, women who had operative births reported less satisfaction with their birth than women who gave birth via vaginal birth. A significant interaction between skin-to-skin and mode of birth showed that although skin-to-skin was associated with higher birth satisfaction among women across all three modes of birth, i.e., vaginal (Cohen's d = .41), instrumental (Cohen's d = .64) and caesarean (Cohen's d = .87), the effect for the difference in birth satisfaction between women with and without skin-to-skin was especially large for operative births, particularly for caesarean sections.

KEY CONCLUSIONS

Operative birth is related to lower satisfaction with childbirth and lower rates of skin-to-skin contact immediately after birth. Yet, the association between skin-to-skin and birth satisfaction is especially strong for women who had operative births and specifically a caesarean section, suggesting that the possible contribution of skin-to-skin to birth satisfaction should be emphasised particularly after operative births.

IMPLICATIONS FOR PRACTICE

It is recommended that maternity care providers, managers, policy makers and medical teams facilitate skin-to-skin contact between the woman and her infant immediately, or as soon as possible, after childbirth, in both operative and non-operative births.

Women's experiences of their involvement around care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia

BACKGROUND

Women who have a caesarean birth can have an experience that may impact decision-making for subsequent births. For some women this decision-making can be associated with anxiety.

AIM

To provide rich, surface level descriptions by exploring women's experiences of their involvement in decision-making during a subsequent pregnancy after a previous caesarean birth.

METHODS

A descriptive qualitative study was performed between May 2018 and February 2019 using Braun and Clarke's six steps guided analysis. Pregnant women with a previous caesarean birth, receiving antenatal care at a tertiary maternity hospital in Western Australia, and self-reported low to moderate levels of anxiety were invited to participate in a telephone interview.

FINDINGS

Women's (n = 17) experiences revealed four themes: 1) Learning from past experiences (two sub-themes loss of control and coming to terms), 2) Claiming ownership in decisions (two sub-themes challenging professional judgement and prioritising her needs, wishes and preferences), 3) Being empowered (three sub-themes getting a full picture, speaking out, and not just the baby or a number), 4) Moving forward (two sub-themes building trust in health professionals and establishing guardrails to minimise loss of control).

DISCUSSION

Women's experiences around decision-making in a subsequent pregnancy can vary according to whether their fears and anxieties are acknowledged and addressed. Women who are informed, and receive support and respect are empowered to move forward.

CONCLUSION

Continuity of care may provide women with more opportunities to build trusting relationships with clinicians and be truly known as an individual with unique preferences and desires.

The Relationship between Nurses' Moral Sensitivity and Patients' Satisfaction with the Care Received in the Medical Wards

Introduction: The quality of care affects patients’ satisfaction. To provide high quality care, nurses face ethical challenges in daily practice. Moral sensitivity is the first phase in moral implementation. This study aimed to determine the relationship between nurses’ moral sensitivity and patients’ satisfaction in medical wards.

Methods: In descriptive correlational study 198 nurses and 198 patients in 17 medical wards filled out the Moral Sensitivity Questionnaire (MSQ) and Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), respectively. Nurses were sampled by the census method. For each nurse, a patient was selected randomly from the same ward. Data were analyzed using SPSS version 13.

Results: The highest scores were in the dimensions of “relational orientation” and “following the rules”, and the lowest scores were in the dimensions of “autonomy” and “experiencing moral conflicts”. The highest level of patients’ satisfaction was with “nurses’ professional performance” 3.98 (1.09), and the lowest level was with “nurses’ routine work” 2.69 (1.22). There was no significant relationship between the mean of patient satisfaction and moral sensitivity of nurses.

Conclusion: Considering that nurses had a higher score in dimension of “following the rules” and a lower score in dimension of “autonomy”, it seems ethical performance in the real situation is not merely due to the nurses’ moral sensitivity and it seems the complexity of the organization causes nurses face difficulties in making decisions related to clinical practice; therefore, policy makers in the health system should be able to identify barriers.

Mother's satisfaction with the existing labor and delivery care services at public health facilities in West Shewa zone, Oromia region, Ethiopia

BACKGROUND

Mothers' satisfaction with care during childbirth is indicators of the quality care which affects skilled birth attendance. Negative client's experiences at health facilities cause them to delay or avoid seeking care, which highlights services providers should consider and act on the expectations and experiences of women and their families. Though there are few studies conducted in Ethiopia on maternal satisfaction with Labor and Delivery (LAD) services, there is no study conducted in the study area. Therefore the study aims to assess the mother's satisfaction with existing LAD services and associated factors at all levels of health care in the West Shewa zone.

METHODS

An institution-based cross-sectional study was conducted at public health facilities in West Shewa zone, Central Ethiopia. A systematic sampling technique was used to select 560 respondents by using their delivery registration number and data were collected through face to face interview. Mothers were considered satisfied if they responded satisfied/very satisfied with 75% or more of the questions assessing satisfaction. Binary and multivariable logistic regression analysis was used to identify associated factors.

RESULTS

The overall proportion of mothers who were satisfied with the current LAD care services were 60.8%. The main areas of dissatisfaction were; accessibility and cleanness of toilets/shower 72.6%, overall cleanness of the facility/including waiting-area 40.1% and presence of support a person during birth 38.0%. The presence of cultural practices (AOR = 2.5), discussion on the place of delivery with health worker during ANC (AOR = 1.75), providers asks for consent before procedure (AOR = 2.77), encouraging companion to remain with mother (AOR = 2.22), never leave mother alone or unattended (AOR = 2.56), giving periodic updates on status and progress of labor (AOR = 2.04) and explaining what is being done and to expect during LAD (AOR = 2.20) were factors identified to be significantly associated with satisfaction on LAD services.

CONCLUSION

The overall satisfaction of mothers with LAD services at public health facilities in the West-Shewa zone was relatively low. Presence of cultural practices, discussion on the place of delivery, asking for consent before the procedure, encouraging companion to remain with mothers and explaining what is being done were factors identified. Therefore, all stakeholders have to emphatically work on those identified factors to improve mothers' satisfaction with LAD services.

Status of national policy on companion of choice at birth in Latin America and the Caribbean: Gaps and challenges

The World Health Organization (WHO) recommends a companion of choice during labor and birth, to improve maternal and perinatal outcomes and women's satisfaction with health services. To better understand the status of companion of choice in Latin America and the Caribbean (LAC), an online survey was conducted with members of a midwifery virtual community of practice and with key informants, aiming to identify: 1) existing regulatory instruments related to companion of choice in the countries where the members are practicing; and, 2) key characteristics of implementation of companion of choice, where regulation exists. Responses (n = 112) were received from representatives of 20 of the 43 countries of LAC. Respondents reported existence of a national policy or legislation in seven countries, ministerial norms or institutional protocols in five countries, and no existing policy/protocol in eight countries. Respondents from the same country often provided contradictory responses. Responses differed from information provided by ministries of health in a WHO-led global policy survey in 11 instances. These variations may reflect that midwives were not always aware of the national policy/guideline in their country. We propose that a more robust effort should be undertaken to understand the status of companion of choice for labor and birth in LAC countries, at national, regional, and local level, in public and private facilities. It is important to know if policies exist, at what level of the system, and if key stakeholders, maternity-care health providers, and women are aware of their existence. Efforts should also be made to understand barriers to implementing companion of choice.

The childbirth experience: obstetric and psychological predictors in Italian primiparous women

BACKGROUND

The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psychological variables on women's subjective experience of childbirth.

METHODS

111 primiparous Italian women completed a set of questionnaires at 38-40 weeks of pregnancy (Time 1) and 1-5 days after childbirth (Time 2). Sociodemographic and obstetric information were collected. Data about the childbirth were obtained from the mother's ward birth records. Women completed the Wijma Delivery Expectancy/Experience Questionnaire both before and after childbirth.

RESULTS

The subjective experience of birth was significantly predicted by the duration of the expulsive phase (β = .26; p < .05), the use of epidural analgesia (β = .21;  p< .05) and by fear of birth (β = .21; p < .05). The effect of mode of birth and duration of the dilatation phase on women's birth experience was not found.

CONCLUSIONS

In our study, neither instrumental childbirth nor caesarean section have a significant effect on women's birth experience. Instead, both a longer expulsion phase and epidural analgesia contribute to the negative experience. Moreover, the higher the fear of birth, the worse the women's emotional experience. These findings confirmed the role of obstetric and psychological variables on birth experience. More investigation about this topic could be useful to develop specific interventions to prepare women for birth.

Implementation of an international standardized set of outcome indicators in pregnancy and childbirth in Kenya: Utilizing mobile technology to collect patient-reported outcomes

Background

Limited data exist on health outcomes during pregnancy and childbirth in low- and middle-income countries. This is a pilot of an innovative data collection tool using mobile technology to collect patient-reported outcome measures (PROMs) selected from the International Consortium of Health Outcomes Measurement (ICHOM) Pregnancy and Childbirth Standard Set in Nairobi, Kenya.

Methods

Pregnant women in the third trimester were recruited at three primary care facilities in Nairobi and followed prospectively throughout delivery and until six weeks postpartum. PROMs were collected via mobile surveys at three antenatal and two postnatal time points. Outcomes included incontinence, dyspareunia, mental health, breastfeeding and satisfaction with care. Hospitals reported morbidity and mortality. Descriptive statistics on maternal and child outcomes, survey completion and follow-up rates were calculated.

Results

In six months, 204 women were recruited: 50% of women returned for a second ante-natal care visit, 50% delivered at referral hospitals and 51% completed the postnatal visit. The completion rates for the five PROM surveys were highest at the first antenatal care visit (92%) and lowest in the postnatal care visit (38%). Data on depression, dyspareunia, fecal and urinary incontinence were successfully collected during the antenatal and postnatal period. At six weeks postpartum, 86% of women breastfeed exclusively. Most women that completed the survey were very satisfied with antenatal care (66%), delivery care (51%), and post-natal care (60%).

Conclusion

We have demonstrated that it is feasible to use mobile technology to follow women throughout pregnancy, track their attendance to pre-natal and post-natal care visits and obtain data on PROM. This study demonstrates the potential of mobile technology to collect PROM in a low-resource setting. The data provide insight into the quality of maternal care services provided and will be used to identify and address gaps in access and provision of high quality care to pregnant women.

Preference for caesarean attitudes toward birth in a Chilean sample of young adults

BACKGROUND

Little empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide.

AIM

To identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures.

METHODS

An online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference.

FINDINGS

Among eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9-14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1-2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0-3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0-6.8) were associated with caesarean preference.

DISCUSSION

Preference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth.

CONCLUSIONS

Patient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.

Dimensions of childbirth care associated with maternal satisfaction among low-risk Chilean women

The authors of this study aimed to describe the level of maternal satisfaction during labor reported by a national sample of low-risk childbearing women in Chile by identifying the dimensions of intrapartum care most determinant for overall satisfaction. Maternal satisfaction was measured in the postpartum period with an instrument previously validated in Chile. Almost half of the participants (49.4%) reported having optimal satisfaction, 29% adequate, and 22% worse. Treatment of women by professionals and the physical environment were the most important dimension predicting of maternal satisfaction, consistent with findings from developing countries emphasizing patient-provider interaction during labor as a key component of birth care quality.

Risk factors for episiotomy during vaginal childbirth: A retrospective cohort study in Western China

OBJECTIVE

To assess the incidence rates and risk factors for episiotomy during vaginal childbirth in a Western China context.

METHODS

A retrospective hospital-based cohort study was conducted using computerized data of 3721 singleton vaginal deliveries after 28 weeks of gestation. Women who underwent episiotomy were compared with those who did not.

RESULTS

The overall prevalence of episiotomy was 44.0% (1636/3721); 52.9% (1458/2756) among primiparas and 18.4% (178/965) among multiparas (P < 0.001). Adjusted risk factors significantly associated with episiotomy included primiparity, prolonged second stage of labor, and labor-management personnel. Risk factors specific to primiparas were increasing maternal age (per year) (OR = 1.04, 95% CI 1.01 to 1.07, P = 0.035), increasing biparietal diameter (per centimeter) (OR = 1.40, 95% CI 1.06 to 1.84, P = 0.017), first stage of labor beyond 10-hour (OR = 1.36, 95% CI 1.10 to 1.68, P = 0.005), and birth weight (per 100 g) (OR = 1.06, 95% CI 1.03 to 1.09, P < 0.001). Birth weight resulted in an adjusted risk increase of 6.1% among primiparas for every 100 additional grams of birth weight. For the analysis stratified by labor-management personnel, moderately experienced midwifery was a risk factor of episiotomy (OR = 1.76, 95% CI 1.21 to 2.56, P = 0.003); midwives with bachelor's degree (OR = 1.47, 95% CI 1.15 to 1.88, P = 0.002), and obstetricians with doctor's degree (OR = 2.00, 95% CI 1.18 to 3.39, P = 0.010) were most likely to perform episiotomy.

CONCLUSION

Episiotomy is still commonly performed in Western China. A survey of maternity care professionals' knowledge of and attitudes towards episiotomy is urgently required to explore the complex reasons for conducting episiotomy.