Beliefs and perceptions of childbearing women choosing different primary health care providers

Continuity of Clinician Type and Intrapartum Experiences During the Perinatal Period in California

INTRODUCTION

Continuity of care with an individual clinician is associated with increased satisfaction and better outcomes. Continuity of clinician type (ie, obstetrician-gynecologist or midwife) may also impact care experiences; however, it is unknown how common it is to experience discontinuity of clinician type and what its implications are for the birth experience. We aimed to identify characteristics associated with having a different clinician type for prenatal care than for birth and to compare intrapartum experiences by continuity of clinician type.

METHODS

For this cross-sectional study, data were from the 2017 Listening to Mothers in California survey. The analytic sample was limited to individuals with vaginal births who had midwifery or obstetrician-gynecologist prenatal care (N = 1384). Bivariate and multivariate analysis examined characteristics of individuals by continuity of clinician type. We then examined associations of clinician type continuity with intrapartum care experiences.

RESULTS

Overall, 74.4% of individuals had the same type of clinician for prenatal care and birth. Of individuals with midwifery prenatal care, 45.1% had a different birth clinician type, whereas 23.5% of individuals who had obstetrician-gynecologist prenatal care had a different birth clinician type. Continuity of clinician type was positively associated with having had a choice of perinatal care clinician. There were no statistically significant associations between clinician type continuity and intrapartum care experiences.

DISCUSSION

Findings suggest individuals with midwifery prenatal care frequently have a different type of clinician attend their birth, even among those with vaginal births. Further research should examine the impact of multiple dimensions of continuity of care on perinatal care quality.

Women's birth beliefs and associated factors in an obstetrics clinic in the Southeastern Anatolian Region of Turkey

Purpose

The impact of birth beliefs on pregnancy and delivery are universally recognized, but the factors that affect birth beliefs vary across regions depending on individual and cultural characteristics. This study aimed to determine women's birth beliefs and examine their associated factors.

Design/methodology/approach

This cross-sectional study was conducted with 548 primiparas in the obstetrics clinic of a university hospital located in the Southeastern Anatolian Region of Turkey from February to June 2019. Descriptive characteristics, form and the Birth Beliefs Scale were used in data collection. To analyze the data, descriptive statistics, T-tests and ANOVA analyses were used.

Findings

It was determined that factors such as age group, income level, any problems during pregnancy and preferred delivery mode statistically affected women's birth beliefs.

Originality/value

Based on the findings from this study, healthcare personnel should provide training and consultation services to pregnant women starting from the prenatal period to help ensure a positive labor experience.

Who Uses a Midwife for Prenatal Care and for Birth in the United States? A Secondary Analysis of Listening to Mothers III

BACKGROUND

Although midwife care is slowly but consistently increasing in the United States, not much is known regarding women who use a midwife. Our objectives were to compare the sociodemographic and health history characteristics, and the quality of patient-provider communication, between women who used a midwife and those who used a physician for prenatal care and/or birth.

METHODS

We performed a cross-sectional analysis of the nationally representative Listening to Mothers III survey. We report descriptive findings using weighted proportions and means with standard deviations. We used the two one-sided tests procedure to assess the equivalence of women who used midwives and those who used physicians.

RESULTS

Nearly 13% of women used a midwife for prenatal care or as a birth attendant. Women who used a midwife for prenatal care were similar to women who used a physician in most sociodemographic and health history characteristics, as well as their patient-provider communication scores, with the exception of the percentage of White (61.7 ± 5.0 [midwives], 54.3 ± 1.5 [physicians]) and married women (68.7 ± 4.9 [midwives], 60.6 ± 1.5 [physicians]). Women who used a midwife as a birth attendant were similar to women who used a physician as a birth attendant in most characteristics, with the exception of age over 35 years (7.5 ± 1.6 [midwives], 15.7 ± 1.1 [physicians]) and Special Supplemental Nutrition Program for Women, Infants, and Children support (56.8 ± 4.9 [midwives], 50.0 ± 1.6 [physicians]).

CONCLUSIONS

Women who use midwives are similar to those who use physicians and our findings do not confirm the common perception that midwife patients are a self-selected group of wealthier, more educated women.

The birth beliefs scale - a new measure to assess basic beliefs about birth

INTRODUCTION

Basic beliefs about birth as a natural and safe or a medical and risky process are central in the decisions on where and how to birth. Despite their importance, they have not been studied separately from other childbirth-related constructs. Our aim was to develop a measure to assess these beliefs.

METHOD

Pregnant Israeli women (N = 850, gestational week ≥14) were recruited in women's health centers, in online natural birth forums, and through home midwives. Participants filled in questionnaires including sociodemographic and obstetric background, the Birth Beliefs Scale (BBS), dispositional desire for control (DC) and planned mode of delivery.

RESULTS

Factor analyses revealed that the BBS is composed of two factors: beliefs about birth as a natural process and beliefs about birth as a medical process. Both subscales showed good internal and test-retest reliability. They had good construct validity, predicted birth choices, and were weakly correlated with DC. Women's medical obstetric history was associated with the BBS, further supporting the validity of the scale.

DISCUSSION

Beliefs about birth may be the building blocks that make up perceptions of birth and drive women's preferences. The new scale provides an easy way to distinctly assess them so they can be used to further understand planned birth behaviors. Additional studies are needed to comprehend how these beliefs form in different cultural contexts and how they evolve over time.

U.S. Nulliparas' Reasons for Expected Provider Type and Childbirth Setting

The objective of this study was to describe nulliparas' reasons for the type of provider (i.e., midwife, physician) and childbirth setting (i.e., home, hospital, hospital-based birth center) that respondents expected for their births. Data were collected via a cross-sectional, descriptive, self-administered, Web-based survey including both close- and open-ended questions and were analyzed using conventional content analysis. Respondents were 220 nulliparous women aged 18-40 years, living in the United States, and pregnant at 20 or fewer weeks' gestation. Women's reasons were categorized broadly as relating to provider/setting attributes, relationship with provider/setting, normative choices, respondent attributes, and practical considerations. Respondents' reasons highlight misconceptions about childbirth care options, especially regarding midwifery and nonhospital settings, which may be addressed by childbirth education.

US nulliparas' perceptions of roles and of the birth experience as predictors of their delivery preferences

OBJECTIVE

to develop a model for understanding predictors of nulliparas' delivery preferences: provider type, setting, mode of delivery and the use/avoidance of pain medication.

DESIGN

a cross-sectional, descriptive, self-administered, web-based survey. The sample was composed of nulliparous women aged 18-40, living in the US and pregnant at 20 or fewer weeks' gestation (n=344). Data were analysed using structural equation modelling.

FINDINGS

women who regard their active participation as effective and essential to the childbearing process are more likely to prefer the care of a midwife, the home as the birth setting, vaginal delivery and the avoidance of pain medication compared to women who see their role as a passive one. When women perceive their provider's role to be more central to the delivery process than their own, they are likely to prefer the care of a physician and the hospital setting. If the provider's role is seen as a collaborative one, women are likelier to prefer midwifery care and planned home birth. The more painful and fearful a woman expects the delivery experience to be, the more likely she is to prefer a caesarean delivery to vaginal birth.

KEY CONCLUSIONS

women's perceptions of (a) their role in pregnancy and delivery, (b) their providers' role in assisting them and (c) the nature of the delivery experience are effective predictors of their delivery preferences.

IMPLICATIONS FOR PRACTICE

providers can help ensure that the informational resources that influence women's perceptions about delivery are factual and evidence-based.

More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour

BACKGROUND

Childbirth is one of the most painful events that a woman is likely to experience, the multi-dimensional aspect and intensity of which far exceeds disease conditions. A woman's lack of knowledge about the risks and benefits of the various methods of pain relief can heighten anxiety. Women are increasingly expected, and are expecting, to participate in decisions about their healthcare. Involvement should allow women to make better-informed decisions; the National Institute for Clinical Excellence has stated that we need effective ways of supporting pregnant women in making informed decisions during labour. Our aim was to systematically review the empirical literature on women's expectations and experiences of pain and pain relief during labour, as well as their involvement in the decision-making process.

METHODS

A systematic review was conducted using the following databases: Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Bath Information and Database Service (BIDS), Excerpta Medica Database Guide (EMBASE), Midwives Information and Resource (MIDIRS), Sociological Abstracts and PsychINFO. Studies that examined experience and expectations of pain, and its relief in labour, were appraised and the findings were integrated into a systematic review.

RESULTS

Appraisal revealed four key themes: the level and type of pain, pain relief, involvement in decision-making and control. Studies predominantly showed that women underestimated the pain they would experience. Women may hope for a labour free of pain relief, but many found that they needed or benefited from it. There is a distinction between women's desire for a drug-free labour and the expectation that they may need some sort of pain relief. Inaccurate or unrealistic expectations about pain may mean that women are not prepared appropriately for labour. Many women acknowledged that they wanted to participate in decision-making, but the degree of involvement varied. Women expected to take control in labour in a number of ways, but their degree of reported control was less than hoped for.

CONCLUSION

Women may have ideal hopes of what they would like to happen with respect to pain relief, control and engagement in decision-making, but experience is often very different from expectations. Antenatal educators need to ensure that pregnant women are appropriately prepared for what might actually happen to limit this expectation-experience gap and potentially support greater satisfaction with labour.

Problematic integration of uncertainty and desire in pregnancy

Although most women in the United States choose physicians for their prenatal care, a small but growing number are now turning to midwives. The disparity between these two models of care has clear implications for the communication that takes place with each type of provider. In this project, the authors seek to understand the mother-midwife relationship by employing a case study approach with multiple data collection methods to examine one woman's struggles with the uncertainties she faces during her pregnancy. The authors employed problematic integration (PI) theory, which illuminates struggles with uncertainty, profound values, and communication, to examine how one woman and her midwife jointly handle and negotiate the dilemmas posed by her pregnancy. The woman's relationship and interactions with her midwife exemplify the midwifery model of care and illuminate the implications that this model has for the joint confrontation of uncertainty and desire during pregnancy.

Childbearing Women’s Perceptions of Nursing Care That Promotes Dignity

OBJECTIVE

To gain an understanding of the perceptions of childbearing women about the maintenance of dignity while laboring and giving birth.

DESIGN

Descriptive qualitative study.

SETTING

A university community in the western United States.

PATIENTS/PARTICIPANTS

Twenty low-risk primiparous women who had recently given birth to healthy term neonates.

MAIN OUTCOME MEASURES

Semistructured audio-taped interviews were conducted in the homes of participants using an interview guide.

RESULTS

The following themes were identified: (a) nurses played a pivotal role in preserving dignity during childbirth, (b) women appreciated feeling valued and respected, and (c) dignity was enhanced by nursing care that gave women their preferred level of control.

CONCLUSION

Nursing behaviors that demonstrate valuing and respect of childbearing women are essential in preserving the quality of the birth experience.

Information for pregnant women about caesarean birth

BACKGROUND

Information is routinely given to pregnant women, but information about caesarean birth may be inadequate.

OBJECTIVES

To examine the effectiveness of information about caesarean birth.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth register, CENTRAL (26 November 2002), MEDLINE [online via PubMed 1966-] and the Web of Science citation database [1995-] (20 September 2002), and reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials, non-randomised clinical trials and controlled before-and-after studies of information given to pregnant women about caesarean birth.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Missing and further data were sought from trial authors unsuccessfully. Analyses were based on 'intention to treat'. Relative risk and confidence intervals were calculated and reported. Consumer reviewers commented on adequacy of information reported in each study.

MAIN RESULTS

Two randomised controlled trials involving 1451 women met the inclusion criteria. Both studies aimed to reduce caesarean births by encouraging women to attempt vaginal delivery. One used a program of prenatal education and support, and the other cognitive therapy to reduce fear. Results were not combined because of differences in the study populations. Non-clinical outcomes were ascertained in both studies through questionnaires, but were subject to rates of loss to follow-up exceeding 10%.A number of important outcomes cannot be reported: knowledge or understanding; decisional conflict; and women's perceptions: of their ability to discuss care with clinicians or family/friends, of whether information needs were met, and of satisfaction with decision-making. Neither study assessed women's perception of participation in decision-making about caesarean birth, but Fraser 1997, who examined the effect of study participation on decision making, found that women in the intervention group were more likely to consider that attempting vaginal birth was easier (51% compared to 28% in control group), or more difficult (10% compared to 6%). These results could be affected by the attrition rate of 11%, and are possibly subject to bias. Neither intervention used in these trials made any difference to clinical outcomes. About 70% or more women attempted vaginal delivery in both trials, yet caesarean delivery rates exceeded 40%, at least 10% higher than was hoped. There was no significant difference between control and intervention groups for any of the outcomes measured: vaginal birth, elective/scheduled caesarean, and attempted vaginal delivery. Outcome data, although similar for both groups, were not sufficient to compare maternal and neonatal morbidity or neonatal mortality. There was no difference in the psychological outcomes for the intervention and control groups reported by either of the included trials. Consumer reviewers said information for women considering a vaginal birth after caesarean (VBAC) should include: risks of VBAC and elective caesarean; warning signs in labour; philosophy and policies of hospital and staff; strategies to improve chances of success; and information about probability of success with specific care givers.

REVIEWER'S CONCLUSIONS

Research has focussed on encouraging women to attempt vaginal delivery. Trials of interventions to encourage women to attempt vaginal birth showed no effect, but shortcomings in study design mean that the evidence is inconclusive. Further research on this topic is urgently needed.

Midwifery care research: what questions are being asked? What lessons have been learned?

PURPOSE

To create and critically evaluate a research database about midwifery care that identifies topics studied, research methods, results, funding, publication data, and implications for a future midwifery research agenda.

METHODS

Systematic literature review. Studies included were 1) data-based research; 2) about midwifery care or practice; 3) in the United States; and 4) published between 1984-1998. The CINAHL and MEDLINE electronic databases were searched using a defined strategy, and relevant journals and bibliographies were searched by hand.

RESULTS

This 15-year review identified 140 studies of midwifery care published in 161 papers. A midwife was the lead author on 60%. Sixty percent were published in the Journal of Nurse-Midwifery. Six to 15 studies were published each year, and both the number of publications and funding increased over the time period. The six major areas of focus were: 1) midwifery management, 2) structure of care, 3) midwifery practice, 4) midwife-physician comparisons, 5) place of birth, and 6) care of vulnerable populations.

DISCUSSION

Although retrospective descriptive studies still predominate, more prospective studies, randomized controlled trials, multi-site studies, and quasi-experimental designs are being conducted. Qualitative methods are helping to measure nontraditional outcomes. A research agenda should be established based on discussion and debate within the profession. Midwife investigators need to build research teams and collaborate with other disciplines. Key areas for future research include alternative therapies, breastfeeding, cost-effectiveness, cultural studies, gynecology, health policy, menopause, postpartum care, substance abuse interventions, and the woman's experience of birth and midwifery care.