Development of a questionnaire for assessing the childbirth experience (QACE)

Empowering Expecting Mothers: The Impact of Antenatal Classes on Child Birth Experience

Introduction Antenatal education is one of the ways to increase a woman's knowledge about pregnancy and childbirth, which could improve self-efficacy during labor, making the expecting mothers well-prepared for labor and nursing. One of the ways for its delivery could be via well-structured antenatal classes. Such classes are part of many countries' healthcare systems and have proven to decline maternal anxiety, shorten labor, increase partner involvement, and overall improve labor experience. However, at the same time, such classes can augment more interventions in labor, induction of labor, and epidural usage. Despite the heterogeneous results of their effect, the high demands of antenatal education among pregnant women can justify its incorporation into antenatal care. By allowing the women to identify labor correctly and preventing admission in false labor, shortening the labor, and teaching women non-pharmacologic ways to manage labor pains, it can reduce the patient and fiscal burden on the already overwhelmed maternity units of Pakistan, hence proving to be an inexpensive health promotion tool. Methods This cross-sectional study was conducted in the Department of Obstetrics and Gynecology of Aga Khan University Hospital Karachi, Pakistan, between December 2020 and June 2021. All pregnant women, aged 18 to 45 years, between gestational ages of 37 to 42 weeks, with singleton, cephalic pregnancy, booked during the first or second trimester, and who attended at least one antenatal class, were invited to participate. Women who had any contraindication to vaginal delivery, whose labor was induced, or who suffered from medical, psychological, or obstetric comorbidities were excused. The participants were observed for labor outcomes in terms of stage of labor on arrival, use of epidural analgesia, mode of delivery, and childbirth experience, using a validated research tool, known as the Questionnaire for Assessing the Childbirth Experience (QACE) to identify women with a positive or negative childbirth experience. A higher score representing on the questionnaire represented a more negative birth experience. A score of less than 19 was considered a positive birth experience. Data was analyzed using IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows, Version 19. Results The mean QACE score was reported as 18.2±3.00, reflecting that on average the mothers had a positive childbirth experience. Modes of delivery revealed 57.6% of the women delivering spontaneously, with 60.4% of them arriving in the labor room in active labor. Demand for labor analgesia in the form of epidural was 64%. Majorly the participants attended only one antenatal class, with 66.91% of women reporting a positive childbirth experience. Conclusion Antenatal education classes are a low-input, high-yielding resource that can be used to empower mothers with pertinent information and support for a pleasant childbirth experience while simultaneously taking the edge off the overburdened maternity wards of low resources, in densely populated countries like Pakistan. Hence it is the need of the hour to devise plans to invest in these classes to make them available to the masses.

Measuring Women's Satisfaction with Childbirth: A Literature Review of Measurement Properties

Introduction

Patient satisfaction is an important indicator of the quality of care provided. Evaluating women's satisfaction with childbirth is essential to improving obstetric care and ensuring a positive experience for mothers and newborns. The tools used to measure women's satisfaction with childbirth are very heterogeneous and multidimensional. Assessment tools used in practice should be tested and meet characteristics that are consistently validated.The aim is to identify currently available instruments measuring women's satisfaction with childbirth and to evaluate their structure, content and psychometric properties.

Methods

A systematic search for sources was carried out according to the criteria set. For the included studies, psychometric properties were assessed in accordance with the principles of the guideline for completing systematic reviews of patient-reported outcome measures, COSMIN.

Results

The review included 31 studies that reported the psychometric properties of six measurement instruments (questionnaires, scales). Content validity, structural validity, internal consistency, reliability and cross-cultural validity were assessed for the included studies. The Childbirth Experience Questionnaire (CEQ/CEQ2) and Birth Satisfaction Scale - Revised (BSS-R) were the most commonly used questionnaires in the studies.

Conclusions

Thorough testing of tools measuring women's satisfaction with childbirth, and adapting them to cultural and social contexts, is still essential. It is crucial that valid and reliable questionnaires are available for midwives in practice, for use in research, to inform clinical practice and for the results to help develop the services offered.

Implementing a Respectful Maternity Care Guideline During Childbirth Experiences

OBJECTIVE

To measure the impact of an evidence-based guideline on respectful maternity care on nurses' attitudes and beliefs about childbirth practices.

DESIGN

A quality improvement pilot project with a pretest/posttest design examining the attitudes and beliefs of intrapartum nurses about childbirth practices of respectful care.

SETTING

High-risk intrapartum unit at a tertiary care center in the southeastern United States.

PARTICIPANTS

A convenience sample of 130 registered nurses were invited to participate, and nine completed the pre- and posttests.

INTERVENTION/MEASUREMENTS

The intervention included a recorded webinar, access to printed and electronic copies of the guideline, discussions in daily huddles, and a virtual journal club. Data were collected using the 42-item Nurse Attitudes and Beliefs Questionnaire-Revised. Lower scores are reflective of attitudes and beliefs that support a medical model of care, whereas higher scores are reflective of a physiologic model of care. Descriptive statistics and the Wilcoxon signed rank test were used to analyze changes in attitudes and beliefs based on the aggregate scores of the nurse participants.

RESULTS

Although there was no change in nurse attitude and beliefs about childbirth practices after 3 months (p = .058), the aggregate scores on a scale of 42 to 168 increased by 5.6 points. Two subscales of the Nurse Attitudes and Beliefs Questionnaire-Revised-Medical Model of Conflict and Women's Autonomy-had the greatest increase in aggregate scores.

CONCLUSION

Understanding nurses' attitudes and beliefs can assist in identifying barriers to the provision of respectful care, particularly during labor and birth, when patients are most vulnerable. Measurement of nurse attitudes and beliefs regarding respectful maternity care may require a longer immersion in a respectful maternity care program to allow for changes over time.

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

OBJECTIVE

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

DATA SOURCES

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

STUDY ELIGIBILITY CRITERIA

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

METHODS

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

RESULTS

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

CONCLUSION

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

Women satisfaction on choosing the cervical ripening method: Oral misoprostol versus balloon catheter

Objective

Induction of labor concerns about 29 % of women in Unites States and 33 % in Europe. Among the various methods for cervical ripening, the efficacy and safety profiles of oral misoprostol and balloon catheter are comparable, but data in the literature on maternal satisfaction during induction of labor are few. The objective of this study was to assess the satisfaction of women who chose the method of cervical ripening, i.e. either balloon catheter or oral misoprostol, for induction of labor.

Study design

This retrospective study asked women who had undergone induction of labor between February 1, 2020 and February 28, 2021. After receiving verbal and written information, the choice of method between oral misoprostol and balloon catheter was left to the patient's free appreciation. Satisfaction was assessed by means of a questionnaire distributed to all women during their stay in the maternity unit. The principal assessment criterion was based on women' inclination to choose the same cervical ripening method if induction of labor were to prove necessary in a future pregnancy, and their willingness to recommend this method to a friend. Univariate analyses were conducted using Student's t-test, Chi-2 test or Fisher's exact test.

Results

On 575 women eligible for analysis, 365 (63.5 %) of these women replied to the satisfaction questionnaire. Of this number, 236 (64.7 %) chose cervical ripening by balloon catheter, and 129 (35.3 %) by oral misoprostol. No significant difference was found between the two groups: 68.2 % of women in the balloon catheter group would opt for the same method of cervical ripening if it proved necessary in a future pregnancy and 64.7% would recommend it to a pregnant friend, versus 65.9 % and 63.6 % in the oral misoprostol group, respectively. Women were overall pleased to be able to choose their method of cervical ripening: 90.5 % of patients in the balloon catheter group and 95.3 % in the oral misoprostol group.

Conclusions

When women choose the method of cervical ripening, satisfaction is overall good, irrespective of the method, whether by balloon catheter or misoprostol.

Offering women a choice in induction of labour: a prospective cohort study

PURPOSE

To evaluate women's choice in the method of labour induction between oral misoprostol, PGE2 pessary and the Foley catheter. To compare women's satisfaction according to their choice and to identify factors associated with patient satisfaction.

METHODS

We conducted a comparative, prospective cohort study of 520 women who chose their preferred method for labour induction, in a French tertiary hospital, from July 2019 to October 2020. Before and after the delivery, they were asked to argue their choice and to evaluate their satisfaction through the use of questionnaires. The primary outcome was global level of satisfaction.

RESULTS

Of the 520 women included, 67.5% of women chose oral misoprostol compared to 21% PGE2 pessary and 11.5% Foley catheter. Regarding global satisfaction, we found no significant difference between the three groups: 78.4%, 68.8% and 71.2% (p = 0.107) for, respectively, oral misoprostol, PGE2 pessary and Foley catheter. Factors that seem to improve women's satisfaction were nulliparity (aOR = 2.03, 95% CI [1.19-3.53]), delivery within 24 h after the start of induction (aOR = 3.46, 95% CI [2.02-6.14]) and adequate information (aOR = 4.21, 95% CI [1.869.64]). Factors associated with lower satisfaction rates were postpartum haemorrhage (aOR = 0.51, 95% CI [0.30-0.88]) and caesarean section (aOR = 0.31, 95% CI [0.17-0.54]).

CONCLUSION

Women satisfaction rates were not different between the three methods, when chosen by the patients themselves. These finding should encourage caregivers to promote shared decision making when possible.

TRIAL REGISTRATION

The protocol was approved by the French ethics committee for research in obstetrics and gynaecology (CEROG, reference number 2019-OBS-0602) on 1st June 2019.

Oxytocin versus prostaglandins for labour Induction of women with an unfavourable cervix after 24 hours of cervical ripening (OPIC): protocol for an open multicentre randomised non-inferiority trial

INTRODUCTION

It remains uncertain whether the most appropriate management for women with an unfavourable cervix after 24 hours of cervical ripening is repeating the ripening procedure or proceeding directly to induction by oxytocin. No adequately powered trial has compared these strategies. We hypothesise that induction of labour with oxytocin among women who have just undergone an ineffective first ripening procedure is not associated with a higher risk of caesarean delivery than a repeated cervical ripening with prostaglandins.

METHODS AND ANALYSIS

We will conduct a multicentre, non-inferiority, open-label, randomised controlled trial aimed at comparing labour induction by oxytocin with a second cervical ripening that uses prostaglandins (slow-release vaginal dinoprostone; oral misoprostol 25 µg; dinoprostone vaginal gel 2 mg). Women (n=1494) randomised in a 1:1 ratio in 10 French maternity units must be ≥18 years with a singleton fetus in vertex presentation, at a term from ≥37+0 weeks of gestation, and have just completed a 24-hour cervical ripening procedure by any method (pharmacological or mechanical) with a Bishop score ≤6. Exclusion criteria comprise being in labour, having more than 3 contractions per 10 min, or a prior caesarean delivery or a history of uterine surgery, or a fetus with antenatally suspected severe congenital abnormalities or a non-reassuring fetal heart rate. The primary endpoint will be the caesarean delivery rate, regardless of indication. Secondary outcomes concern delivery, perinatal morbidity, maternal satisfaction and health economic evaluations. The nature of the assessed procedures prevents masking the study investigators and patients to group assignment.

ETHICS AND DISSEMINATION

All participants will provide written informed consent. The ethics committee 'Comité de Protection des Personnes Ile de France VII' approved this study on 2 April 2021 (No 2021-000989-15). Study findings will be submitted for publication and presented at relevant conferences.

TRIAL REGISTRATION NUMBER

NCT04949633.

Insights into women's experiences of giving birth during the coronavirus disease-19 pandemic in Jordan, a cross-sectional survey

BACKGROUND

Since 2019, the coronavirus disease-19 pandemic and its consequences from restrictions to risks have impacted our lives in all aspects. Pregnant women are especially vulnerable to the changes that were implemented as a result of the shift in healthcare priorities and the medical and social implications of the lockdown.

OBJECTIVES

This study aimed to assess the experience of giving birth during the pandemic, how this is affected by acquiring coronavirus disease-19 infection, and its effect on postnatal mood.

DESIGN

A cross-sectional study was conducted which involved 490 women who gave birth during the pandemic across the Hashemite Kingdom of Jordan.

METHODS

An electronic questionnaire was distributed among women experiencing childbirth during this period in Jordan by advertising it on social media platforms targeting pregnant women and mothers. The sample size was statistically determined to be representative of the population. Statistical analysis was performed using Statistical Package for the Social Sciences for Windows v.27.

RESULTS

The study demonstrated that getting infected with the virus throughout the pregnancy did not affect the childbirth experience with respect to the parameters measured, but other factors during the pandemic such as the type of hospital and mode of delivery did. Positive interaction with staff in the delivery suite was a major determinant of a positive birth experience. Women associated low mood post-delivery with giving birth in pandemic circumstances, and it affected first-time mothers more than multiparous women.

CONCLUSION

Although the acquisition of coronavirus disease-19 infection did not have a significant impact on women's childbirth experience, several pandemic-related factors did. Given the importance of a woman's perception and evaluation of events surrounding her birth experience in determining her postnatal physical and psychological well-being, having to give birth during the pandemic circumstances, especially for first-time mothers, can have potentially detrimental consequences that may affect her health and reproductive choices in the future. The results of this study offer a better understanding of the effect of pandemic and lockdown circumstances on the perceived experience of mothers during childbirth and postnatally and factors that should be taken into consideration when planning healthcare provision to this population in future similar conditions.

'Labour Hopscotch': Women's evaluation of using the steps during labor

INTRODUCTION

Concerns have been expressed globally about the decline in rates of physiological birth and rising intervention rates during labor and birth. The 'Labour Hopscotch' Framework, a visual depiction of steps required to remain active during labor was implemented in a large tertiary maternity hospital in Ireland. The aim of this study was to evaluate the steps of the Labour Hopscotch women found most useful, examine the use of non-pharmacological and pharmacological methods of pain relief used during labor and finally to investigate the labor and birth outcomes of women who used 'Labour Hopscotch' during labor.

METHODS

A descriptive cross-sectional study was conducted using a study specific questionnaire.

RESULTS

A total of 809 women completed the questionnaire. The Labour Hopscotch Framework was positively evaluated. Mobilizing, the birthing ball, birthing stool, and water therapy were found to be the most useful steps. Primiparous women were more likely to use non-pharmacological methods of pain relief. Pharmacological methods used by women were entonox (67.5%), pethidine (8%) and epidural analgesia (38.5%). Primiparous women were more likely to have epidural analgesia than multiparous women (p<0.00001). Women that attended either private (p=0.004) or public-led obstetric (p=0.005) antenatal care were more likely to have epidural analgesia in labor. Women attending the community midwives were least likely to receive epidural analgesia during labor. The rates of spontaneous vaginal birth, assisted birth and cesarean section, were 77.1%, 14% and 8.7%, respectively.

CONCLUSIONS

Our study findings contribute to the increasing national and international evidence that initiatives such as Labour Hopscotch can promote and advocate for women to be active and mobile during labor to support physiological birth.

Effectiveness of a peanut ball device during labour on maternal and neonatal outcomes: protocol for a randomised controlled trial

Frequent positional changes and movements during labour is one of the recommendations by the World Health Organization (WHO) to prevent prolonged labour, thereby avoiding cesarean sections. However, labour induction, continuous fetal monitoring in supine position and immobilising the women during labour are standard practices in most private hospitals. To combat these problems and to implement WHO recommendations, the peanut ball is an effective device through which frequent positional changes will be achieved without disrupting the labour procedures. The current study aims to evaluate the effectiveness of the peanut ball device during labour on maternal and neonatal outcomes and assess the stress response induced by labour in terms of maternal and neonatal cortisol in low-risk primigravid women. The study is a prospective, block randomised controlled trial with parallel arms. A total of 768 study participants will be randomised to the peanut-ball group (intervention) and standard care group (control). The intervention group will receive different peanut ball positions during labour at or after 4 cm of cervical dilatation. The primary outcomes of the study are maternal outcome that includes measurement of duration of the active and the second stage of labour, stress level as measured by serum cortisol level at 3-4 cm and at 10 cm of cervical dilatation, mode of delivery, perception of pain, behavioural response during the active stage of labour and neonatal outcomes, which includes the pattern of fetal heart rate, APGAR score, birth injuries, and umbilical serum and salivary cortisol level. The collected data will be compared between the intervention and control groups.  Trial Registration: This research is registered under the CTRI (Clinical Trials Registry of India) ( CTRI/2019/08/020802) (21/8/2019).

The experience of giving birth: a prospective cohort in a French perinatal network

Background

To assess women's positive and negative perceptions after giving birth. The secondary objectives were to identify the women who had a negative perception of their delivery, define the risk factors, and propose actions that maternity units can take to improve their management.

Methods/design

This study was a multicenter, prospective cohort, conducted in 23 French maternity units constituting one perinatal network, in 2019. All adult women who understood French and gave birth between February 1 and September 27, 2019, were eligible. The exclusion criterion was the woman's objection to participation. Validated self-administered questionnaire (QACE) was sent by email 6 weeks after the child's birth. The main outcome was the experience of childbirth, assessed on a scale of 0 to 10. A good experience was defined by a score ≥ 8/10, and a poor experience by a score < 5. A multinomial logistic regression model, expressed by cumulative proportional odds ratios, were used to determine the factors that might have affected women's experiences during childbirth.

Results

Two thousand one hundred and thirty-fifth women completed the questionnaire, for a participation rate of 49.6%. Overall, 70.7% (n = 1501/2121) of the women reported a good experience, including 38% (n = 807/2121) who graded their experience with the maximum score of 10. On the other hand, 7.3% (n = 156) of the women reported a poor experience. Vaginal delivery (aOR 3.93, 95%CI, 3.04–5.08) and satisfactory management (aOR 11.35 (7.69–16.75)) were the principal determining factors of a positive experience. Epidural analgesia increased the feeling of failure (aOR 5.64, 95%CI, 2.75–13.66). Receiving information and being asked for and agreeing to consent improved the global experience (P = 0.03).

Conclusion

The Identikit picture of the woman associated with a poor experience of childbirth shows a nullipara who had a complication during her pregnancy, gave birth after induction of labor, or by cesarean or operative vaginal delivery, with the newborn transferred for pediatric care, and medical management considered unsatisfactory.

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development

This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.

An informative video before planned cesarean delivery and maternal anxiety-a multicenter randomized controlled trial

BACKGROUND

Cesarean delivery is one of the most common procedures performed in obstetrics, and although cesarean delivery is a blissful occasion, it is commonly associated with fear and anxiety for the new mother.

OBJECTIVE

We aimed to study the impact of watching a detailed, informative video on maternal anxiety levels, childbirth experience, and patient satisfaction in patients undergoing a primary cesarean delivery.

STUDY DESIGN

We performed a multicenter randomized control trial. Women scheduled to undergo a primary nonemergent cesarean delivery were recruited. All participants in the intervention group watched an informative video on recruitment. This 4-minute video described in detail the expected cesarean delivery process: preparations before entering the operation room, regional anesthesia administration, sterile covering, the surgical procedure itself, and recovery (including mobilization and lactation). Situation-specific anxiety was measured at recruitment, before exposure to the video (S1), at the day of the operation (S2), and at postpartum day 1 (S3) using the State-Trait Anxiety Inventory score. In addition, participants answered a 10-item Childbirth Experience Questionnaire. A sample size of 63 per group was planned to achieve 80% power to detect a difference of 5 points in the primary outcome (State-Trait Anxiety Inventory score on the day of the operation).

RESULTS

Overall, 154 participants from 4 medical centers were randomized, and 132 participants were analyzed after completing all questionnaires, 64 participants in the video group and 68 participants in the control group. The groups did not differ in demographics and delivery characteristics and had similar baseline anxiety levels (S1). On operation day (S2, the primary outcome), significantly lower anxiety levels were reported in the video group than in the control group (State-Trait Anxiety Inventory scores, 41.3±9.5 vs 49.3±10.3; P<.001). Moreover, anxiety levels in postpartum day 1 (S3) remained significantly lower in the video group (P<.001). No difference between the groups in childbirth experience score or patient satisfaction was demonstrated.

CONCLUSION

A detailed informative video shown to patients before primary cesarean delivery decreased maternal anxiety levels before and after the procedure.

[Posttraumatic stress disorder and emergency cesarean delivery: Incidence and risk factors]

BACKGROUND

Posttraumatic stress disorder (PTSD) is declared in 3 to 6 % of postpartum women (PP) and up to 18.5 % in cases of complications of pregnancy or childbirth. The objective of this study is to assess the prevalence of PTSD after a red code cesarean section and to identify the risk factors among the prenatal vulnerability factors, the birth alert factors and the maintenance factors in PP.

METHOD

A phone or computerized questionnaire including an Questionnaire de stress immédiat and the Posttraumatic Stress Disorder Checklist for DSM-5 was offered to patients who had a red code cesarean section between 05/12/2015 and 02/28/2021 at the University South Hospital of Reunion Island.

RESULTS

Among the 555 cesarean sections selected, 329 parturients responded. The prevalence of PTSD was 20.1 % and was stable over time. The 2 risk factors found were the negative experience of childbirth and the proven traumatic experience. Prenatal vunerability factors were not found to be statistically significant. Almost 3 in 4 women had not been informed of the risk of cesarean section and more than 1 in 2 women did not have an explanation in PP.

CONCLUSION

Red code cesarean sections cause PTSD in 1 in 5 women. This lasting disorder can last up to 6 years after childbirth. This indicates the seriousness of this disorder and the need to prevent it. The risk of developing it is 4 times greater in the event of a traumatic experience proven in the Questionnaire de stress immédiat. Offering this questionnaire in the maternity could be an important element of secondary prevention. The role of health personnel remains essential.

Women's satisfaction with childbirth in a public hospital in Brazil

OBJECTIVE

The purpose of this study was to evaluate women's satisfaction with vaginal birth in a public hospital in São Paulo, Brazil.

METHODS

A total of 372 low-risk postpartum women were interviewed. Maternal satisfaction was measured by the Mackey Childbirth Satisfaction Rating Scale (MCSRS), validated to Brazilian Portuguese. The scale is divided into six subscales: self-evaluation, partner, baby, nursing, physicians, and overall satisfaction. Childbirth care data were related to maternal mobility, shower bath, birth ball exercises, manual massage, and the health care providers assisting delivery.

RESULTS

The MCSRS total score was significantly higher in women living with their partners than those not living with a partner (median 145.5 vs 133.0; P = 0.019), in women with a companion during childbirth than those with no labor support (146.0 vs 136.5; P = 0.047), and in women who early breastfed within the first hour compared with those who did not (146.0 vs 137.0; P = 0.001). Multiple regression identified 'living with partner' (coefficient 6.205; P = 0.043) and 'breastfeeding within the first hour' (coefficient 7.856; P = 0.005) as independent variables that determine the total score of MCSRS.

CONCLUSIONS

Our findings indicate that living with one's partner and early initiation of breastfeeding are key factors enhancing satisfaction with vaginal birth in women who received care at a public Brazilian hospital.

Childbirth experience, maternal functioning and mental health: how are they related?

Introduction: Childbirth experience is shaped by the labor and delivery process. The aim of this study was to investigate the relationship between childbirth experience, subsequent postpartum maternal functioning and mental health.Methods: A total of 483 mothers in the first 4-16 weeks postpartum participated in this cross-sectional study. The cluster random sampling method was used to select the participants. The Questionnaire for Assessing the Childbirth Experience, Mental Health Inventory, and the Barkin Index of Maternal Functioning were completed through interviews.Results: The mean childbirth experience, mental health, and maternal functioning scores were 1.6 (0.4), 79.1 (15.0), and 97.4 (13.0), respectively. There was a significant correlation between the total mental health and maternal functioning scores and all its subscales with childbirth experience scores (P<0.001). Results from the general linear model pointed to a significant correlation between maternal functioning and childbirth experience (P<0.001), as well as between receiving support for infant care (P<0.001) and family income adequacy (P=0.006). Mental health was also significantly correlated with childbirth experience (P<0.001), complete life satisfaction (P<0.001), and receiving support for infant care (P=0.025).Conclusion: Supportive care provision services may improve mothers' birth experiences, which leads to enhanced postpartum maternal functioning and mental health.

Predictors of Negative Childbirth Experiences Among French Women

OBJECTIVES

To describe the prevalence of negative childbirth experiences and to identify potential predictors, including demographic, prenatal, obstetric, and psychological factors, of these experiences among French women.

DESIGN

Descriptive, correlational, cross-sectional study.

SETTING

A maternity ward in a hospital located near Paris, France.

PARTICIPANTS

A total of 256 women between the ages of 18 and 46 years were recruited while hospitalized in the maternity ward 1 to 6 days after childbirth.

METHODS

Participants completed a personal information form and five self-report scales: the Dyadic Adjustment Scale, the General Self-Efficacy Scale, the State-Trait Anxiety Inventory, the Relationship Scales Questionnaire, and the Questionnaire Assessing the Childbirth Experience. We performed linear regression analyses and used scores on the Questionnaire Assessing the Childbirth Experience as the dependent variable. We considered prenatal, psychological, and obstetric factors as independent variables and adjusted results for covariates.

RESULTS

The prevalence of a negative childbirth experience was 23.3% among our participants. We identified primiparity, high anxiety trait scores, and an anxious attachment style as the prenatal variables that contributed significantly to negative perceptions of childbirth based on the first step of the regression analysis (R² = .18; p < .001). We evaluated objective birth-related variables during the second step and found that mode of birth and use of epidural analgesia were significative predictors of the negative childbirth experience (R² = 0.36; p < .001). The last set of variables included subjective birth-related factors, such as absence of the partner during birth and low perceived sense of control; these variables increased the explained variance from 36% to 69% (p < .001) and showed that these aspects were powerful predictors of a negative childbirth experience.

CONCLUSIONS

Given that some prenatal factors influence women's perceptions of their birth experiences, preventive measures can be implemented by health professionals to support women with risk factors. In the early postpartum period, health care professionals should focus on subjective variables of childbirth because they strongly predict the overall childbirth experience for women.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis

Background

Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran.

Methods

This research is a qualitative study conducted in Iran to explore women’s perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis.

Results

From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.

Conclusion

Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03666-z.

Development and psychometric properties of Iranian women childbirth experience questionnaire

Aim

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

Design

Cross‐sectional study.

Methods

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

Result

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

Validation and psychometric properties of the Spanish version of the questionnaire for assessing the childbirth experience (QACE)

OBJECTIVE

When evaluating childbirth experience, some of the factors considered by women include their previous births experience, pain management during birth, and companion and healthcare professional support received. The objective of this paper is to validate the Questionnaire for Assessing the Childbirth Experience (QACE) into the Spanish population by assessing its psychometric properties.

METHODS

Due to the differences between the Spanish and English languages, a careful translation process was the first step to making the QACE useable to Spanish speaking cohorts, once thoroughly translated their conceptual equivalence was evaluated by a group of experts and tested later via interviews with postpartum women for comprehensibility evaluation. Secondly, the validation process was obtained throughout the factorial analysis, internal consistency, test-retest evaluation and convergent and discriminant validity.

RESULTS

A total of 268 postpartum women participated in the validity study. The KMO (0.84) and Bartlett test (p < 0.001) confirmed the adequacy of factor analysis and the Screen plot showed four factors with the predictive power of 52.63%, which supported total variance. Confirmatory factor analysis indicated an adequate/good fitness for the new model (χ²/df = 1.47, GFI = 0.979, RMSEA = 0.052, CFI = 0.889, NFI = 0.727, NNFI = 0.873, and SRMR = 0.155). Internal consistency was confirmed with McDonal's Omega level of 0.818. Test-retest evaluation supported test stability (r = 0.79, p < 0.01). Convergent and discriminant validity were obtained with 0.803 and 0.475 Pearson coefficients respectively.

CONCLUSIONS

The Spanish version of QACE is a relevant tool for measuring childbirth experience into the Spanish context with acceptable validity and stability.

[Validation of the questionnaire for assessing the childbirth experience (QACE) in a French population]

BACKGROUND

A woman's negative perception of her subjective childbirth experience can have consequences on the mother's psychological state and on early mother-baby relationships. To date, there is no validated tool in France allowing to evaluate childbirth experience in a multidimensional way. The aim of this study is to validate the Questionnaire Assessing the Childbirth Experience (QEVA) in a French sample of mothers. This tool was developed in a previous study where the authors combined 25 items into 6 dimensions: representations and expectations, sensory perceptions, feeling of control, perceived social support (medical staff and partner), emotions (positive and negative) and first moments with the baby.

METHODS

The sample included 256 women recruited in a maternity ward. Sociodemographic and obstetric characteristics of our sample were compared to those of the French national perinatal survey. The structure of the QEVA with 17 items was explored by an exploratory structural equation modeling (ESEM). An analysis of the internal consistency was conducted on the sub-scores of the identified factors, and the concurrent validity was assessed with the Peri-traumatic Distress Inventory (PDI) through a correlation and its associated t-test.

RESULTS

The characteristics of our sample and those of the national perinatal survey do not differ on age, marital status, parity, cannabis use, infertility treatment, epidural and baby weight, in favour of the good representativeness of our sample. The study of the QEVA structure revealed a 4-dimensional structure. Analysis of the psychometric qualities showed a good internal consistency, with an observed alpha value ranging from 0.69 to 0.86. The QEVA also shows a good concurrent validity with the peri-traumatic distress scores (r=0.51).

CONCLUSION

To date, the QEVA is the first standardized tool allowing a multidimensional evaluation of the subjective experience of childbirth. It has been validated on a French population using an exploratory structural equation modeling. This tool, which is simple to use and well accepted by mothers, enables health professionals not only to screen mothers experiencing difficult childbirth and in need of support, but also to adapt health care according to the dimensions of the birth experience and its associated difficulties (emotions during the birth, interactions with health professionals, first moments with the baby, or post-partum emotions).

[Determinants of Anxiety Symptoms, Depression and Peri-traumatic Distress in Immediate Postpartum Women's mental health]

OBJECTIVES

The aims of this study were to identify the determinants and the vulnerability factors of women's mental health in the immediate postpartum period by investigating the first symptoms of anxiety, depression and peri-traumatic distress.

METHODS

256 women participated in this cross-sectional and descriptive study. They responded during their stay in the maternity ward to a set of questionnaires between the 1st and the 6th day after delivery. This included an anamnestic questionnaire as well as different scales that evaluated generalized self-efficacy feeling (GSES), marital adjustment (DAS), perceived sense of control during labor and delivery (LAS), birth experience (QEVA), anxiety manifestations (STAI-Y), depressive symptoms (EPDS) and peri-traumatic distress (PDI).

RESULTS

Symptoms of anxiety, depression and peri-traumatic distress in the immediate postpartum period, as indicators of women's mental health, are predicted by different determinants. An anxious personality and perceived complications during childbirth for the woman or baby have been shown to be significant predictors of postpartum anxiety. Symptoms of depression are related to a history of depression, a low overall sense of general efficacy and lower satisfaction in the marital relationship. Peri-traumatic distress is related to certain dimensions of the childbirth experience, such as perceived sense of control, perceived complications and emotions felt during birth.

CONCLUSIONS

Symptoms of depression, anxiety and peritraumatic distress are linked to aspects of the prenatal period, but also to the experience of childbirth. More specific prevention, screening and care measures, depending on the woman's symptomatology, can be implemented during pregnancy or at the maternity. Further research seems essential to better understand the interactions between the prenatal period, childbirth and postpartum in explaining women's mental health in the immediate postpartum period.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the childbirth experience questionnaire

BACKGROUND

The Childbirth Experience Questionnaire (CEQ) is a tool designed to assess women's perceptions about labor and delivery. The aim of this study was to perform the cross-cultural adaptation and validation of the Brazilian Portuguese version of the CEQ (CEQ-Br).

METHODS

The original version of the CEQ was translated into Portuguese, analyzed by a committee of experts, back translated, and finally submitted to pilot-test. Two applications of the CEQ-Br were performed along with the quality of life questionnaire Medical Outcomes Study 36 - Item Short-Form Health Survey (SF-36). The SPSS software was used for statistical analysis, the intraclass correlation coefficient was used to investigate test-retest reliability, the internal consistency was investigated with the Cronbach's Alpha, and the construct validity was investigated via the Spearman correlation test. The level of significance was set at 5%.

RESULTS

The study included 308 women with a mean age of 31.1 ± 8.7 years. The internal consistency results for the total CEQ-Br score was considered adequate (0.89), the test-retest showed a substantial result with an ICC of 0.90, and the construct validity was analyzed via the Spearman correlation between all SF-36 dimensions and the total CEQ-B score, the analyses were considered adequate.

CONCLUSIONS

The results presented in this CEQ-Br validation study showed that the instrument was reliable in measuring the established psychometric properties and was considered valid. Therefore, the CEQ-Br can be applied to the Brazilian population.

Cross-cultural validation and psychometrics' evaluation of women's experience of maternity care scale in French: the ESEM

BACKGROUND

Evaluating women's satisfaction should reflect the entire maternity care experience (antenatal, intrapartum and postnatal). The Women's Experience Maternity Care Scale (WEMCS) questionnaire enables this assessment. The purpose of this study was to translate in French, adapt and explore the psychometric properties of the WEMCS and to determine the best cut-off on the optimal satisfaction for the three scales.

METHODS

Backward, forward translation and cross-cultural adaptation were processed to validate the French version of WEMCS: Échelle de Satisfaction de l'Experience des soins en Maternité (ESEM). Psychometric tests assessed the questionnaire, which includes three scales, such as construct validity, internal consistency, Cronbach's alpha coefficients and ceiling and floor effects. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values for optimal satisfaction. Reproducibility was verified by test-retest reliability.

RESULTS

Primiparas with uncomplicated pregnancies were recruited antenatally at the University Hospital of Geneva. Of the 229 patients who agreed to participate, 202 women (88.2%) returned the test and retest questionnaires. Principal component analysis for the antenatal, intrapartum and postnatal scales suggested the unidimensional character of the three scales; Cronbach's alpha coefficients were high for the three scales with values of > 0.85. Construct validity based on the five-point Likert scale values showed a Spearman's rho correlation of r = 0.56 for the antenatal scale (p < 0.001) and r = 0.62 for the intrapartum scale (p < 0.001), as well as a strong correlation with the postnatal scale, with r = 0.78 (p < 0.001). Optimum cut-off scores for the ROC curve of the antenatal, intrapartum and postnatal scores were equal to or higher than 48, 50 and 70, respectively. The three scales showed good sensitivity and good specificity. The stability of the ESEM questionnaire was confirmed by intra-class correlation coefficients of > 0.80. However, the three scales revealed ceiling effects.

CONCLUSION

The psychometric proprieties of the ESEM demonstrate it's ability to evaluate the quality of perinatal health care. The ESEM should be tested in the context of different models of women's care and with women with different degrees of pregnancy complications to explore the validity of this scale.

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

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