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González-Mesa E, González-Cazorla A, González-Cazorla E, Mozas-Moreno J, Gokce Isbir G, Abreu W, Lubián-López D. Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences. J Psychosom Obstet Gynaecol 2024; 45:2380860. [PMID: 39044401 DOI: 10.1080/0167482x.2024.2380860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.
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Affiliation(s)
- Ernesto González-Mesa
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
- Grupo de investigación en Medicina Materno-fetal, epigenética, enfermedades de la mujer y salud reproductiva, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- UGC Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana González-Cazorla
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
| | | | - Juan Mozas-Moreno
- School of Medicine, Obstetrics and Gynecology Department, University of Granada, Granada, Spain
| | | | - Wilson Abreu
- Psychology School, Centro de Investigacao en Tecnologias y Servicios de Saude, Porto University, Porto, Portugal
| | - Daniel Lubián-López
- Obstetrics and Gynecology Department, University Hospital of Jerez de la Frontera, Cádiz, Spain
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Attanasio L, Jeung C, Geissler KH. Association of Postpartum Mental Illness Diagnoses with Severe Maternal Morbidity. J Womens Health (Larchmt) 2024; 33:778-787. [PMID: 38153367 DOI: 10.1089/jwh.2023.0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: This study aimed to determine whether birthing people who experience severe maternal morbidity (SMM) are more likely to be diagnosed with a postpartum mental illness. Materials and Methods: Using the Massachusetts All Payer Claims Database, this study used modified Poisson regression analysis to assess the association of SMM with mental illness diagnosis during the postpartum year, accounting for prenatal mental illness diagnoses and other patient characteristics. Results: There were 128,161 deliveries identified, with 55.0% covered by Medicaid. Of these, 3.1% experienced SMM during pregnancy and/or delivery hospitalization, and 20.1% had a mental illness diagnosis within 1 year postpartum. In adjusted regression analyses, individuals with SMM had a 10.6% increased risk of having any mental illness diagnosis compared to individuals without SMM, primarily due to an increased risk of a depression or post-traumatic stress disorder diagnosis among people with SMM than those without SMM. Conclusions: Individuals who experienced SMM had a higher risk of a mental illness diagnosis in the postpartum year. Given increases in SMM in the United States in recent decades, policies to mitigate mental health sequelae of SMM are urgently needed.
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Affiliation(s)
- Laura Attanasio
- Department of Health Promotion and Policy, University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts, USA
| | - Chanup Jeung
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York-University at Albany School of Public Health, Albany, New York, USA
| | - Kimberley H Geissler
- Department of Healthcare Delivery and Population Sciences, UMass Chan Medical School-Baystate, Springfield, Massachusetts, USA
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Distinguishing High-Performing From Low-Performing Hospitals for Severe Maternal Morbidity. Obstet Gynecol 2022; 139:1061-1069. [DOI: 10.1097/aog.0000000000004806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
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Hutchens J, Frawley J, Sullivan EA. Cardiac disease in pregnancy and the first year postpartum: a story of mental health, identity and connection. BMC Pregnancy Childbirth 2022; 22:382. [PMID: 35501828 PMCID: PMC9063289 DOI: 10.1186/s12884-022-04614-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Women with cardiac disease in pregnancy and the first year postpartum often face uncertainty about their condition and the trajectory of their recovery. Cardiac disease is a leading cause of serious maternal morbidity and mortality, and the prevalence is increasing. Affected women are at risk of worsening cardiac disease, chronic illness, mental illness and trauma. This compounded risk may lead to significant and long-term negative outcomes. The aim of this study is to correct the lack of visibility and information on the experiences of women with cardiac disease in pregnancy and the first year postpartum. Methods A qualitative study using in-depth semi-structured interviews with twenty-five women who had acquired, congenital or genetic cardiac disease during pregnancy or the first year postpartum. Data were analysed and interpreted using a thematic analysis framework. Results Analysis of the interviews produced three major themes: 1) Ground zero: index events and their emotional and psychological impact, 2) Self-perception, identity and worthiness, and 3) On the road alone; isolation and connection. There was a narrative consistency across the interviews despite the women being diverse in age, cardiac diagnosis and cardiac health status, parity and timing of diagnosis. The thread prevailing over the temporal and clinical differences was one of distress, biographical disruption, identity, isolation, a necessitated re-imagining of their lives, and the process of multi-layered healing. Conclusion Acknowledging and understanding the breadth, complexity and depth of women’s experiences is fundamental to improving outcomes. Our findings provide unique insights into women’s experiences and challenges across a spectrum of diseases. Most women did not report an isolated trauma or distressing event, rather there was a layering and persistence of psychological distress necessitating enhanced assessment, management and continuity of care beyond the routine 6-week postpartum check. Further research is required to understand long-term outcomes and to refine the findings for specific disease cohorts to be able to respond effectively.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Elizabeth A Sullivan
- Faculty of Health and Medicine, University of Newcastle, University Dr, Callaghan, NSW, 2308, Australia
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Fatin Imtithal A, Norhayati MN, Nor Akma Y. Comparison of labour and postnatal satisfaction between women with and without severe maternal morbidity: a double-cohort study. BMJ Open 2022; 12:e049757. [PMID: 35418419 PMCID: PMC9014019 DOI: 10.1136/bmjopen-2021-049757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To compare labour and postnatal satisfaction between women with and without severe maternal morbidity in a tertiary hospital in Kelantan, Malaysia. DESIGN A prospective double-cohort study. SETTING Hospital and community based. PARTICIPANTS Women at childbirth and 1-month post partum. OUTCOME MEASURES Labour satisfaction measured using the Malay version of the Women's Views of Birth Labour Satisfaction Questionnaire and postnatal satisfaction measured using the Malay version of the Women's Views of Birth Postnatal Satisfaction Questionnaire. RESULTS A total of 198 participants responded following childbirth, while 193 responded 1-month post partum. Accordingly, although no significant difference in labour satisfaction scores following childbirth was observed between women with and without severe maternal morbidity, a significant difference in postnatal satisfaction score 1-month post partum had been noted (adjusted mean difference [95% CI]: 3 [0.54 to 5.45]; p=0.019). Moreover, domains for nursing a baby (0.08 [0.024] vs 0.06 [0.029]; p=0.022) and professional support (0.03 [0.022] vs 0.03 [0.029]; p=0.023) differed significantly between women with and without severe maternal morbidity. CONCLUSIONS Healthcare professional support and nursing of babies influenced the relationship between satisfaction and severe maternal morbidity during the later postpartum period.
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Affiliation(s)
- Adnan Fatin Imtithal
- Department of Family Medicine, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Mohd Noor Norhayati
- Department of Family Medicine, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
| | - Yunus Nor Akma
- Department of Family Medicine, Universiti Sains Malaysia, Kampus Kesihatan, Kubang Kerian, Kelantan, Malaysia
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González-Mesa E, Rengel-Díaz C, Riklikiene O, Thomson G, Cazorla-Granados O, Abreu W, Morgado-Neves D, Gökçe Isbir G, Jonsdottir SS, Karlsdóttir SI, Lalor J. Assessment of the attitude towards childbirth in health sciences students - development and validation of the questionnaire Cave-St. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01892-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AbstractThe purpose of this study is to report on the validation process of a questionnaire that explores health science students’ attitudes towards women’s childbirth experiences. This questionnaire can help inform education programs to enhance the quality of woman-professional interactions, and to improve women’s experiences of childbirth. A standardized procedure for the development and validation of the questionnaire included: item development and psychometric pre-validation, Cronbach’s Alpha coefficient calculation, test–retest and item-total correlation for the reliability analysis. Content validity was undertaken by Delphi method with sixteen panelists over two rounds. We determined the factor structure and refined and validated the questionnaire according to the responses of a cohort of 560 students using principal components factor analysis with varimax rotation. Confirmatory factor analysis was undertaken. A 52-items questionnaire CAVE-st: (acronym for cuestionario de actitudes sobre vivencias y experiencias en el parto) was developed and validated. The results of the factor analysis finally revealed four latent dimensions. The questionnaire CAVE-st is a valid and reliable tool to assess health science students’ attitude towards women’s childbirth experiences. Further work to translate and adapt the instrument in other cultures and languages will be undertaken.
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Greene RA, McKernan J, Manning E, Corcoran P, Byrne B, Cooley S, Daly D, Fallon A, Higgins M, Jones C, Kinsella I, Murphy C, Murphy J, Bhuinneain MN. Major obstetric haemorrhage: Incidence, management and quality of care in Irish maternity units. Eur J Obstet Gynecol Reprod Biol 2021; 257:114-120. [DOI: 10.1016/j.ejogrb.2020.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
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Wang E, Glazer KB, Sofaer S, Balbierz A, Howell EA. Racial and Ethnic Disparities in Severe Maternal Morbidity: A Qualitative Study of Women's Experiences of Peripartum Care. Womens Health Issues 2021; 31:75-81. [PMID: 33069559 PMCID: PMC7769930 DOI: 10.1016/j.whi.2020.09.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Racial and ethnic disparities in rates of maternal morbidity and mortality in the United States are striking and persistent. Despite evidence that variation in the quality of care contributes substantially to these disparities, we do not sufficiently understand how experiences of perinatal care differ by race and ethnicity among women with severe maternal morbidity. METHODS We conducted focus groups with women who experienced a severe maternal morbidity event in a New York City hospital during their most recent pregnancy (n = 20). We organized three focus groups by self-identified race/ethnicity ([1] Black, [2] Latina, and [3] White or Asian) to detect any within- and between-group differences. Discussions were audiotaped and transcribed. The research team coded the transcripts and used content analysis to identify key themes and to compare findings across racial and ethnic groups. RESULTS Participants reported distressing experiences and lasting emotional consequences after having a severe childbirth complication. Many women appreciated the life-saving care they received. However, poor continuity of care, communication gaps, and a perceived lack of attentiveness to participants' physical and emotional needs led to substantial concern and disappointment in care. Black and Latina women in particular emphasized these themes. CONCLUSIONS This study highlights missed opportunities for improved clinician communication and continuity of care to address emotional trauma when severe obstetric complications occur, particularly for Black and Latina women. Enhancing communication to ensure that women feel heard and informed throughout the birth process and addressing implicit bias, as a part of the more systemic issue of institutionalized racism, could both decrease disparities in obstetric care quality and improve the patient experience for women of all races and ethnicities.
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Affiliation(s)
- Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Kimberly B Glazer
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shoshanna Sofaer
- American Institutes for Research, Washington, District of Columbia; Graduate School of Public Health and Health Policy, City University of New York, New York, New York
| | - Amy Balbierz
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Elizabeth A Howell
- Blavatnik Family Women's Health Institute, Icahn School of Medicine at Mount Sinai, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Munch S, McCoyd JLM, Curran L, Harmon C. Medically high-risk pregnancy: Women's perceptions of their relationships with health care providers. SOCIAL WORK IN HEALTH CARE 2020; 59:20-45. [PMID: 31714182 DOI: 10.1080/00981389.2019.1683786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 08/27/2019] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this article is to examine women's perceptions of the patient-provider relationship in the context of medically high-risk pregnancy (MHRP). Sixteen in-depth interviews were conducted with women hospitalized for MHRP on a maternal-fetal medical unit in the US. Tenets of phenomenology guided the data analysis. We found that beyond normative stress related to managing physical aspects of MHRP, women reported added emotional stressors associated with navigating the fragmented health care environment. This study suggests that improved care coordination and systematic integration of psychosocial professionals within the perinatal interdisciplinary health care team are vital to reduce care-related stressors on this vulnerable patient group.
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Affiliation(s)
- Shari Munch
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Judith L M McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Laura Curran
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Cara Harmon
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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McCoyd JLM, Curran L, Munch S. They Say, “If You Don’t Relax…You’re Going to Make Something Bad Happen”: Women’s Emotion Management During Medically High-Risk Pregnancy. PSYCHOLOGY OF WOMEN QUARTERLY 2019. [DOI: 10.1177/0361684319883199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how women with medically high-risk pregnancy manage their emotions while worried about their pregnancies. This study aimed to phenomenologically explore 16 hospitalized women’s emotional reactions and coping during medically high-risk pregnancy with a focus on how emotion management techniques were utilized and what rationales women used for employing them, along with their interpretations of health care providers’ and family members’ advice regarding emotional expression. Respondents universally feared that experienced stress and the resulting distress (negative emotions such as anxiety, sadness, and anger) could harm their fetus. They experienced double binds including believing they must “be positive” to enhance fetal health, despite anxiety and sadness; feeling responsible for housework yet being told not to do it; and needing medical treatments they feared would harm their fetus. In attempting to avoid tears and fears, they expended tremendous energy, leaving themselves depleted and less able to cope. Ubiquitous “think positive” messages amplify women’s sense of failure when distress due to the medically high-risk pregnancy spills over. With little attention to women’s emotional experiences, even to the point of complimenting them as “good incubators,” health care providers may unintentionally shift emotional labor onto vulnerable women. Understanding women’s needs for assistance with emotion management during medically high-risk pregnancy provides important guidance for development of best practices for this population.
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Affiliation(s)
- Judith L. M. McCoyd
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Laura Curran
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Shari Munch
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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Silveira MS, Galvão LPL, Gurgel RQ, Barreto IDC, Vargas MM. Ansiedade e Depressão na Morbidade Materna Grave e Near Miss. PSICOLOGIA: TEORIA E PESQUISA 2019. [DOI: 10.1590/0102.3772e35442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Com o objetivo de verificar a prevalência da ansiedade e depressão em mulheres com morbidade materna grave (near miss), foi realizado estudo de coorte transversal, com 549 mulheres. Para tanto, foram utilizados o Inventário de Beck de Depressão (BDI) e o Inventário de Ansiedade (BAI). Na análise estatística, aplicaram-se o teste do qui-quadrado de Pearson e o U-Mann-Whitney, além de Razões de Chances brutas e seus Intervalos com 95% de confiança. Houve maior prevalência e maior chance de desenvolver a ansiedade e depressão na MMG/NM, bem como a relação positiva e significativa entre ambos. Considera-se a associação do ponto de vista psicológico, como um fator grave e impactante na saúde mental da mulher.
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