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Stoll K, Bendyshe-Walton TA, Av-Gay G, Parajulee A, Humber N, Williams K, Skinner T, Kornelsen J. Perinatal Outcomes at Rural Hospitals That Participated in the Rural Surgical and Obstetrical Networks (RSON) of British Columbia (2016-2021). J Obstet Gynaecol Can 2024; 46:102280. [PMID: 37949367 DOI: 10.1016/j.jogc.2023.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/25/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND The goal of the Rural Surgical and Obstetrical Networks (RSON) of British Columbia was to support safe and appropriate surgery, operative birth, and perinatal care closer to home for rural communities. Family physicians with enhanced obstetrical and/or surgical skills provide cesarean delivery and family practice anesthetists manage anesthesia for labour pain and operative births at RSON-supported hospitals, with the involvement of a local specialist at one site. OBJECTIVES The objectives of the study were to: (1) compare perinatal outcomes at hospitals participating in the RSON initiative with outcomes at referral hospitals and (2) examine temporal changes in the proportion of childbearing people who resided in RSON communities and gave birth locally. METHODS Poisson regression analysis was used to model the effect of hospital type (RSON vs. referral) on perinatal outcomes. We restricted the analysis to singleton births and controlled for differences in maternal characteristics, obstetric history, and pregnancy complications. RESULTS Childbearing people who gave birth at RSON-supported hospitals (n = 3498) had a 10% lower incidence of adverse maternal-newborn outcomes compared to those who gave birth at referral hospitals (n = 14 772), after controlling for referral bias. We found a small increase (3.2 %) in the proportion of local births over the study period. CONCLUSION Findings provide evidence that childbearing people can safely give birth at smaller rural hospitals in British Columbia and that investments in rural hospitals contribute to service stability. Stabilizing local birth services in rural communities benefits the whole region because it reduces surgical overload in regional referral centres.
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Affiliation(s)
- Kathrin Stoll
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC.
| | | | - Gal Av-Gay
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Anshu Parajulee
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Nancy Humber
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Kim Williams
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Tom Skinner
- Rural Coordination Center of British Columbia, Vancouver, BC
| | - Jude Kornelsen
- Centre for Rural Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
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Hill J, Zinsser LA, Wiemer A, Gross MM, Stoll K. Intrapartum time intervals and transfer of nulliparae from community births to maternity care units in Germany. Birth 2024; 51:39-51. [PMID: 37593788 DOI: 10.1111/birt.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Over one-third of nulliparae planning births either at home or in freestanding midwife-led birthing centers (community births) in high-income countries are transferred during labor. Perinatal data are reported each year in Germany for women planning community birth. So far, data sets have not been linked to describe time-related factors associated with nulliparous transfer to hospital. OBJECTIVES To describe the prevalence of referral for nulliparae and assess maternal and labor characteristics associated with intrapartum transfer. METHODS Perinatal data from 2010 to 2015 were linked (n = 26,115). Women were reviewed with respect to international eligibility criteria for community birth; 1997 women were excluded (7.6%). Descriptive statistics were reported; unadjusted and adjusted odds ratios with 95% confidence intervals (CI) tested the predictive effect of demographic and labor factors on rates of intrapartum transfer. RESULTS One in three nulliparous women (30.6%) were transferred to hospital. Compared with community births, transferred women were significantly more likely to experience longer time intervals during labor: from rupture of membranes (ROM) until birth lasting 5 to 18 h (OR 6.05, CI 5.53-6.61) and 19 to 24 h (OR 10.83, CI 9.45-12.41) compared to one to 4 h; and from onset of labor until birth 11 to 24 h (OR 6.72, CI 6.24-7.23) and 25 to 29 h (OR 26.62, CI 22.77-31.11) compared to one to 10 h. When entering all factors into the model, we found the strongest predictors of transfer to be fetal distress, longer time intervals between ROM until birth and onset of labor until birth. CONCLUSIONS Nulliparous transfer rates were similar to rates in other high-income countries; 94% of referrals were non-urgent. Time was found to be an independent risk factor for the transfer of nulliparae planning community birth.
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Affiliation(s)
- Janice Hill
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Midwifery Research, Institute of Health Sciences, Faculty of Medicine, University of Tübingen, Tubingen, Germany
| | - Laura A Zinsser
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Anke Wiemer
- Society for Quality in Out of Hospital Birth (QUAG), Hinter den Höfen 2, Storkow, Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Kathrin Stoll
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, Canada
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Johnston C, Fairbrother N, Butska L, Stoll K. Systematic Screening for Perinatal Anxiety and why it Matters. J Obstet Gynaecol Can 2024; 46:102240. [PMID: 37827330 DOI: 10.1016/j.jogc.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 09/24/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Carly Johnston
- Faculty of Medicine, Vancouver Fraser Medical Program, University of British Columbia, Vancouver, BC
| | | | - Luba Butska
- Midwifery Program, Department of Family Practice, University of British Columbia, BC
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, BC.
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Taiwo TK, Goode K, Niles PM, Stoll K, Malhotra N, Vedam S. Perinatal Mood and Anxiety Disorder and Reproductive Justice: Examining Unmet Needs for Mental Health and Social Services in a National Cohort. Health Equity 2024; 8:3-13. [PMID: 38250299 PMCID: PMC10797170 DOI: 10.1089/heq.2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Perinatal Mood and Anxiety Disorders (PMADs) are the most common complications during the perinatal period. There is limited understanding of the gaps between need and provision of comprehensive health services for childbearing people, especially among racialized populations. Methods The Giving Voice to Mothers Study (GVtM; n=2700), led by a multistakeholder, Steering Council, captured experiences of engaging with perinatal services, including access, respectful care, and health systems' responsiveness across the United States. A patient-designed survey included variables to assess relationships between race, care provider type (midwife or doctor), and needs for psychosocial health services. We calculated summary statistics and tested for significant differences across racialized groups, subsequently reporting odds ratios (ORs) for each group. Results Among all respondents, 11% (n=274) reported unmet needs for social and mental health services. Indigenous women were three times as likely to have unmet needs for treatment for depression (OR [95% confidence interval, CI]: 3.1 [1.5-6.5]) or mental health counseling (OR [95% CI]: 2.8 [1.5-5.4]), followed by Black women (OR [95% CI]: 1.8 [1.2-2.8] and 2.4 [1.7-3.4]). Odds of postpartum screening for PMAD were significantly lower for Latina women (OR [95% CI]=0.6 [0.4-0.8]). Those with midwife providers were significantly more likely to report screening for anxiety or depression (OR [95% CI]=1.81 [1.45-2.23]) than those with physician providers. Discussion We found significant unmet need for mental health screening and treatment in the United States. Our results confirm racial disparities in referrals to social services and highlight differences across provider types. We discuss barriers to the integration of assessments and interventions for PMAD into routine perinatal services. Implications We propose incentivizing reimbursement schema for screening and treatment programs; for community-based organizations that provide mental health and social services; and for culture-centered midwife-led perinatal and birth centers. Addressing these gaps is essential to reproductive justice.
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Affiliation(s)
- Tanya Khemet Taiwo
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Bastyr University Department of Midwifery, Kenmore, Washington, USA
| | - Keisha Goode
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- SUNY Old Westbury, Old Westbury, New York, USA
- National Association of Certified Professional Midwives, Keene, New Hampshire, USA
| | - P. Mimi Niles
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Rtory Meyers College of Nursing, New York University, New York, New York, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Limmer CM, Stoll K, Vedam S, Leinweber J, Gross MM. Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool. Midwifery 2023; 126:103809. [PMID: 37689053 DOI: 10.1016/j.midw.2023.103809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 06/27/2023] [Accepted: 08/29/2023] [Indexed: 09/11/2023]
Abstract
INTRODUCTION Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. RESEARCH AIM The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. METHODS A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FINDINGS More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). CONCLUSIONS This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.
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Affiliation(s)
- Claudia M Limmer
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Department Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Science, Alexanderstr. 1, Hamburg D-20099, Germany
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Saraswathi Vedam
- UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada
| | - Julia Leinweber
- Institute of Midwifery, University Medicine Berlin, Charite, Oudenarder Strasse 16, Berlin 13347, Germany
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany.
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Lísa Sigurðardóttir V, L Mangindin E, Stoll K, Marie Swift E. Childbirth experience questionnaire 2 - Icelandic translation and validation. Sexual & Reproductive Healthcare 2023; 37:100882. [PMID: 37399759 DOI: 10.1016/j.srhc.2023.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The aim of this study was to translate the Childbirth Experience Questionnaire (CEQ2) to Icelandic and assess its psychometric characteristics. METHODS The CEQ2 was translated to Icelandic using forward-to-back translation and tested for face-validity (n = 10). Then data was collected in an online survey to test validation in terms of reliability and construct validity (n = 1125). Reliability was assessed by calculating Cronbach's alpha for the total scale and subscales. Cronbach's alpha > 0.7 was regarded as satisfactory. Construct validity was measured using known-groups validation with data collected on women's birth outcomes known to be associated with more positive birth experiences. A comparison was made of CEQ2 subscale scores and total CEQ2 score for country of origin, social complications, parity, pregnancy complications, birthplace, mode of birth, maternal autonomy and decision making (MADM), and mothers on respect index (MORi). Mann WhitneyUand Kruskal Wallis H tests were used to compare scale scores between the groups. Principal components analysis with varimax rotation was chosen to determine whether the Icelandic version of the CEQ had similar psychometric properties as the original version. RESULTS The face validity and internal consistency reliability (Cronbach's alpha > 0.85 for the total scale and all subscales) of the Icelandic version of CEQ2 was good. Our findings indicate that two of the items in the 'own capacity' domain were not sufficiently related to other items of the scale to warrant inclusion. CONCLUSIONS The Icelandic CEQ2 is a valid and reliable measure of childbirth experience but further work is needed to determine the optimal number of items and domains of the Icelandic CEQ2.
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Affiliation(s)
- Valgerður Lísa Sigurðardóttir
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Iceland; Landspitali National University Hospital, Womeńs Clinic, Iceland.
| | - Edythe L Mangindin
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Iceland; Reykjavik Birth Center, Reykjavik, Iceland
| | - Kathrin Stoll
- Department of Family Practice, Faculty of MedicineUniversity of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Faculty of Nursing and Midwifery, School of Health Sciences, University of Iceland, Iceland; Reykjavik Birth Center, Reykjavik, Iceland
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Niles PM, Baumont M, Malhotra N, Stoll K, Strauss N, Lyndon A, Vedam S. Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter? Reprod Health 2023; 20:67. [PMID: 37127624 PMCID: PMC10152585 DOI: 10.1186/s12978-023-01584-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 02/16/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. METHODS We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. RESULTS Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65-7.45), higher respect (aOR: 5.39, 95% CI: 3.72-7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10-0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66-4.27), respect (aOR: 4.15, 95% CI: 2.81-6.14), mistreatment (aOR: 0.20, 95% CI: 0.11-0.34), time spent (aOR: 8.06, 95% CI: 4.26-15.28). CONCLUSION Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.
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Affiliation(s)
- P. Mimi Niles
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Monique Baumont
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Nisha Malhotra
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Nan Strauss
- Every Mother Counts, 333 Hudson St Suite 1006, New York, NY 10013 USA
| | - Audrey Lyndon
- New York University, 433 First Avenue, Room 644, New York, NY 10010 USA
| | - Saraswathi Vedam
- University of British Columbia, BC Women’s Hospital, Shaughnessy Building E416 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Stoll K. Author response to "Pitfalls of analyzing perinatal outcomes by health care provider". CMAJ 2023; 195:E590. [PMID: 37094876 PMCID: PMC10125187 DOI: 10.1503/cmaj.148391-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Kathrin Stoll
- Health researcher, Department of Family Practice, University of British Columbia, Vancouver, BC
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Mangindin EL, Stoll K, Cadée F, Gottfreðsdóttir H, Swift EM. Respectful maternity care and women's autonomy in decision making in Iceland: Application of scale instruments in a cross-sectional survey. Midwifery 2023; 123:103687. [PMID: 37121063 DOI: 10.1016/j.midw.2023.103687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 03/23/2023] [Accepted: 04/08/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To explore how maternal factors are associated with women's experiences of respect and autonomy in Icelandic maternity care. DESIGN An online survey was developed including two measures assessing the quality of perinatal care: the Mothers on Respect Index and the Mothers' Autonomy in Decision Making Scale. Median and interquartile ranges were calculated for both scales. Logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals to investigate the relationship between maternal factors and perceived low levels of respectful care and perceived low levels of autonomy in decision making. PARTICIPANTS AND SETTING A total of 1,402 women participated. Requirements were: Age ≥ 18 years; antenatal care and childbirth in Iceland 2015-2021; and fluency in Icelandic, English or Polish. MEASUREMENTS AND FINDINGS Perceived lower levels of respect were reported by migrant women [aOR 2.16 (1.55-3.00)], women with at least one social complication [aOR 2.52 (1.92-3.31)], primiparous women [aOR 1.72 (1.26-2.36)], women with at least one pregnancy complication [aOR 1.63 (1.22-2.18)] and those who gave birth by caesarean section [aOR 1.75 (1.25-2.45)]. Perceived lower levels of autonomy were reported by migrant women [aOR 1.42 (1.02-1.97)], women who had at least one social complication [aOR 2.12 (1.63-2.74)] and those who gave birth in a hospital setting [aOR 1.62 (1.03-2.55)]. KEY CONCLUSION The results shed light on inequity in Icelandic maternity care and suggest that data from such surveys can provide valuable information on the changes that must be made in maternity health care services to ensure equity. IMPLICATIONS FOR PRACTICE Action must be taken to increase provision of respectful, woman-centred maternity care with an emphasis on informed decision making. Strategies to improve services for groups that have been socially marginalized, such as migrant women and women affected by social determinants of health, should be implemented and monitored.
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Affiliation(s)
- Edythe L Mangindin
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland; Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavík, Iceland.
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Franka Cadée
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
| | - Helga Gottfreðsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland; Department of Obstetrics and Gynecology, Women's Clinic, Landspítali University Hospital, Reykjavík, Iceland
| | - Emma M Swift
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
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Schoene BEF, Oblasser C, Stoll K, Gross MM. Midwifery students witnessing violence during labour and birth and their attitudes towards supporting normal labour: A cross-sectional survey. Midwifery 2023; 119:103626. [PMID: 36842428 DOI: 10.1016/j.midw.2023.103626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/08/2022] [Accepted: 02/05/2023] [Indexed: 02/13/2023]
Affiliation(s)
- Bettina E F Schoene
- Midwifery Research and Education Unit, Hannover Medical School, Germany; now: FHM, University of Applied Sciences, Germany.
| | - Claudia Oblasser
- Midwifery Research and Education Unit, Hannover Medical School, Germany; now: IMC University of Applied Sciences Krems, Austria
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Germany.
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Clark E, Vedam S, Mclean A, Stoll K, Lo W, Hall WA. USING THE DELPHI METHOD TO VALIDATE INDICATORS OF RESPECTFUL MATERNITY CARE FOR HIGH RESOURCE COUNTRIES. J Nurs Meas 2023; 31:120-144. [PMID: 35705228 DOI: 10.1891/jnm-2021-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose: Consistent measurement of respectful maternity care (RMC) is lacking. This Delphi study assessed consensus about indicators of RMC. Methods: A multidisciplinary panel assessed items (n = 201) drawn from global literature. Over two rounds, the panel rated importance, relevance, and clarity, and ranked priority within 17 domains including communication, autonomy, support, stigma, discrimination, and mistreatment. Qualitative feedback supported the analysis. Results: In Round One, 191 indicators exceeded a content validation index of 0.80. In Round Two, Kendall's W ranged from 0.081 (p = .209) to 0.425 (p < .001) across domains. Fourteen indicators received strong support. Changes in indicator assessment between rounds prevented agreement stability assessment. Conclusion: The indicators comprise a registry of items for use in perinatal care research.
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Affiliation(s)
- Esther Clark
- School of Nursing, The University of British Columbia, Vancouver, Canada
| | - Saraswathi Vedam
- Principal, Birth Place Lab, Professor, UBC Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC
| | - Alison Mclean
- Community Engagement Coordinator, Birth Place Lab, Midwifery Program, Department of Family Practice, Faculty of Medicine, Vancouver, BC Canada
| | - Kathrin Stoll
- Honorary Research Associate, Birth Place Lab, Midwifery Program, Department of Family Practice, Faculty of Medicine, Vancouver, BC, Canada
| | - Winnie Lo
- NHS England and NHS Improvement, Skipton House, London, UK
| | - Wendy A Hall
- Professor Emerita, UBC School of Nursing, Vancouver, BC, Canada
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Stoll K, Titoria R, Turner M, Jones A, Butska L. Perinatal outcomes of midwife-led care, stratified by medical risk: a retrospective cohort study from British Columbia (2008-2018). CMAJ 2023; 195:E292-E299. [PMID: 36849178 PMCID: PMC9970624 DOI: 10.1503/cmaj.220453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Anecdotal evidence suggests that the profile of midwifery clients in British Columbia has changed over the past 20 years and that midwives are increasingly caring for clients with moderate to high medical risk. We sought to compare perinatal outcomes with a registered midwife as the most responsible provider (MRP) versus outcomes among clients with physicians as their MRP across medical risk strata. METHODS This retrospective cohort study (2008-2018) used data from the BC Perinatal Data Registry. We included all births that had a family physician, obstetrician or midwife listed as the MRP (n = 425 056) and stratified the analysis by pregnancy risk status (low, moderate or high) according to an adapted perinatal risk scoring system. We estimated differences in outcomes between MRP groups by calculating adjusted absolute and relative risks. RESULTS The adjusted absolute and relative risks of adverse neonatal outcomes were consistently lower among those who chose midwifery care across medical risk strata, compared with clients who had a physician as MRP. Midwifery clients experienced higher rates of spontaneous vaginal births, vaginal births after cesarean delivery and breastfeeding initiation, and lower rates of cesarean deliveries and instrumental births, with no increase in adverse neonatal outcomes. We observed an increased risk of oxytocin induction among high-risk birthers with a midwife versus an obstetrician as MRP. INTERPRETATION Our findings suggest that compared with other providers in BC, midwives provide safe primary care for clients with varied levels of medical risk. Future research might examine how different practice and remuneration models affect clinical outcomes, client and provider experiences, and costs to the health care system.
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Affiliation(s)
- Kathrin Stoll
- Department of Family Practice (Stoll), University of British Columbia; Provincial Health Services Authority (Titoria); Midwifery Program (Turner, Butska), Department of Family Practice, University of British Columbia; Women's Health Research Institute (Jones), BC Women's Hospital, Vancouver, BC
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Stoll K, Titoria R, Johnston C, Butska L. Beyond Medically Complex Pregnancy: A Scoping Review to Understand How Complexity in Pregnancy is Conceptualized. J Midwifery Womens Health 2023; 68:71-83. [PMID: 36269023 DOI: 10.1111/jmwh.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/18/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The goal of this scoping review was to better understand how complexity in pregnancy is conceptualized. Specific objectives were to (1) identify factors that are conceptualized in the literature as complicating or impacting pregnancy; and (2) summarize tools and programs that have been implemented to support pregnant people with complex care needs. METHODS Electronic databases were searched from January 2000 to July 2020 and supplemented by bibliographic searches and citation chaining, to identify articles that described at least one nonmedical and one medical risk factor during pregnancy. We focused on complexity prior to the onset of labor and only included primary studies conducted in middle- or high-income countries. More than 6000 records were screened independently by 3 reviewers at the abstract and title level. RESULTS Fourteen articles met inclusion criteria. Eight studies described antenatal risk scoring systems, including the Florida Healthy Start Prenatal Risk Screen, the Kindex risk screening tool, the prenatal event history calendar, and the Rotterdam Reproductive Risk Reduction score card. We abstracted 85 medical factors and 25 nonmedical factors from the literature. Nonmedical factors that were conceptualized as complicating pregnancy or birth could be grouped into 4 domains: characteristics of the childbearing person (7 factors), socioeconomic conditions (7 factors), family and social life (5 factors), and psychoemotional health (6 factors). DISCUSSION We found limited scholarly research and few assessment tools that broaden the discussion of complexity in pregnancy beyond medical multimorbidity. Multiple dimensions of health should be integrated into a complexity framework for pregnancy that account for the diverse contexts and needs of pregnant people. An important part of this process is the development of a shared language to describe complexity that is strength based and acknowledges how environments, health care encounters, and the larger sociocultural context can affect pregnant people's medical status in pregnancy.
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Affiliation(s)
- Kathrin Stoll
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Reena Titoria
- Provincial Services Health Authority, Vancouver, Canada
| | - Carly Johnston
- Medical Education Program, University of British Columbia, Vancouver, Canada
| | - Luba Butska
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, Canada
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Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
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Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
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Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
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Fairbrother N, Collardeau F, Albert A, Stoll K. Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth. Int J Environ Res Public Health 2022; 19:ijerph19042223. [PMID: 35206412 PMCID: PMC8872365 DOI: 10.3390/ijerph19042223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/27/2022]
Abstract
Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.
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Affiliation(s)
- Nichole Fairbrother
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
- Correspondence:
| | - Fanie Collardeau
- Department of Psychology, Faculty of Social Sciences, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC V6H 2N9, Canada;
| | - Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
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Tomazin KJDCG, Miot HA, Stoll K, Gonçalves IR, Spiri WC, Felipe TRL, Jamas MT. Cross-cultural Adaptation and Validation of the Childbirth Fear Prior to Pregnancy Scale in Brazil. Open Nurs J 2021. [DOI: 10.2174/1874434602115010179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The fear of childbirth can range from apprehension to intense fear (tokophobia), with serious consequences for maternal health. Therefore, a standardized scale is needed to measure the fear of childbirth before pregnancy.
Objective:
This study aimed to adapt the Childbirth Fear Prior to Pregnancy (CFPP) scale to the Brazilian context and analyse its validity and reliability.
Methods:
A cross-sectional survey was completed by 146 nursing students at two Brazilian universities. A committee of experts evaluated the cross-cultural adaptation of the CFPP scale. Construct validity was verified using item-total correlations and Exploratory Factor Analysis (EFA). The validity of divergent concurrent criteria was evaluated by associating the score obtained using the Brazilian CFPP with the Depression, Anxiety, and Stress Scale (DASS-21). Reliability was analysed using Cronbach’s alpha coefficient and test-retest.
Results:
Correlation analysis revealed a predominance of moderate inter-item correlation and strong item-total correlation (>0.62). The EFA indicated that all items related to a single factor, with factor loadings and communalities >0.5. These results reinforced the one-dimensionality of the Brazilian CFPP. The validity of divergent concurrent criteria was confirmed via weak correlations with DASS-21 scores (r = 0.32, p < 0.001). The Cronbach’s alpha (0.86) and the intra-class correlation coefficient (0.99) indicated reliability and strong temporal stability, respectively.
Conclusion:
The Brazilian version of the CFPP provides evidence of validity and reliability to measure fear of childbirth before pregnancy in young adults in Brazil.
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Zinsser LA, Stoll K, Gross MM. Challenges in using Mental Contrasting with Implementation Intentions (MCII) for preparation for natural birth: A feasibility study. Sex Reprod Healthc 2021; 29:100642. [PMID: 34186269 DOI: 10.1016/j.srhc.2021.100642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women who plan a natural birth can benefit from strategies and/or resources that help them prepare for and cope with labour pain. This study aims to identify the feasibility of using Mental Contrasting with Implementation Intentions (MCII) for preparation of primiparous women for natural childbirth. Secondary aims are to test the acceptability of a health-focused information leaflet, and to describe how participants with high natural birth intentions cognitively prepare for birth. METHODS In third trimester, ten primiparous women participated in this interventional study with follow-up. A health-focused information leaflet on physiological childbirth, MCII, a mental strategy that helps people achieve a desired goal by envisioning obstacles and how to overcome them, and a researcher-developed questionnaire which contained the CBSEI-C32, was used. Survey data were analysed using a combination of descriptive statistics and deductive theoretical thematic analysis. RESULTS The health-focused leaflet was exclusively judged positively. Nine women did not use MCII as instructed, they did not find it helpful for childbirth preparation and wished to have a more positive, health-focused approach towards childbirth. Two themes emerged from the participants' responses: 'the ability to give birth' which was supported through childbirth preparedness, coping strategies, confidence and external supports and 'the uncertainty of giving birth' which included fears and worries about possible adverse events and the baby's health. CONCLUSION MCII was not a promising tool for natural childbirth preparation among primiparous women in Germany. Our findings show that women prefer a positive, health-focused approach, rather than thinking about overcoming obstacles, when they prepare for childbirth.
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Affiliation(s)
- Laura A Zinsser
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany; University of British Columbia, Midwifery Program, Faculty of Medicine, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Zinsser LA, Schmidt G, Stoll K, Gross MM. Challenges in applying the short Childbirth Self-Efficacy Inventory (CBSEI-C32) in German. Eur J Midwifery 2021; 5:18. [PMID: 34179731 PMCID: PMC8212888 DOI: 10.18332/ejm/136453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/06/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study aimed to review and pilot-test feedback from childbearing women who completed the German short version of the Childbirth Self-Efficacy Inventory (CBSEI-C32), which is widely used and validated in different languages. METHODS Ten pregnant nulliparas, who planned a natural childbirth, completed the German CBSEI-C32 and provided comments about the comprehensibility of the tool. RESULTS When applying the standardized translated German CBSEI-C32, we discovered that women generally gave positive feedback, and reported that the items made them think about coping strategies for labor and birth. Some pregnant woman had problems in understanding two items: ‘Mich beherrschen’ (original English item: ‘Keep myself in control’), and ‘Mich ruhig halten’ (original English item: ‘Keep myself calm’). Some of the items were not comprehensible for pregnant women and might not represent contemporary concepts of childbirth self-efficacy. CONCLUSIONS Two items of the German CBSEI-C32 were interpreted ambiguously by the pilot testers. The CBSEI should be checked to identify which items could serve as the basis for a new questionnaire because there are clear and appropriate coping strategies when dealing with labour pain such as item 3 on breathing. These could be complemented with other coping behaviours that are positively worded and serve to empower rather than restrain women. For measuring self-efficacy beliefs in childbirth nowadays, it appears that health-oriented aspects, such as concentrating on the pauses between contractions or mentally staying in the present moment, are more important for women than focusing on control during childbirth.
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Affiliation(s)
- Laura A Zinsser
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Gaby Schmidt
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Kathrin Stoll
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany.,Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
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Niles PM, Stoll K, Wang JJ, Black S, Vedam S. "I fought my entire way": Experiences of declining maternity care services in British Columbia. PLoS One 2021; 16:e0252645. [PMID: 34086795 PMCID: PMC8177419 DOI: 10.1371/journal.pone.0252645] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 05/19/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The 2016 WHO Standards for improving quality of maternal and newborn care in health facilities established patient experience of care as a core indicator of quality. Global health experts have described loss of autonomy and disrespect as mistreatment. Risk of disrespect and abuse is higher when patient and care provider opinions differ, but little is known about service users experiences when declining aspects of their maternity care. METHODS To address this gap, we present a qualitative content analysis of 1540 written accounts from 892 service users declining or refusing care options throughout childbearing with a large, geographically representative sample (2900) of childbearing women in British Columbia who participated in an online survey with open-ended questions eliciting care experiences. FINDINGS Four themes are presented: 1) Contentious interactions: "I fought my entire way", describing interactions as fraught with tension and recounting stories of "fighting" for the right to refuse a procedure/intervention; 2) Knowledge as control or as power: "like I was a dim girl", both for providers as keepers of medical knowledge and for clients when they felt knowledgeable about procedures/interventions; 3) Morbid threats: "do you want your baby to die?", coercion or extreme pressure from providers when clients declined interventions; 4) Compliance as valued: "to be a 'good client'", recounting compliance or obedience to medical staff recommendations as valuable social capital but suppressing desire to ask questions or decline care. CONCLUSION We conclude that in situations where a pregnant person declines recommended treatment, or requests treatment that a care provider does not support, tension and strife may ensue. These situations deprioritize and decenter a woman's autonomy and preferences, leading care providers and the culture of care away from the principles of respect and person-centred care.
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Affiliation(s)
- P. Mimi Niles
- Meyers College of Nursing, New York University, New York, NY, United States of America
| | - Kathrin Stoll
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessie J. Wang
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stéphanie Black
- MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Stoll K, Wang JJ, Niles P, Wells L, Vedam S. I felt so much conflict instead of joy: an analysis of open-ended comments from people in British Columbia who declined care recommendations during pregnancy and childbirth. Reprod Health 2021; 18:79. [PMID: 33858469 PMCID: PMC8048186 DOI: 10.1186/s12978-021-01134-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 04/02/2021] [Indexed: 12/16/2022] Open
Abstract
Background No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended. Methods In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. Results More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences. Conclusions Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
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Affiliation(s)
- Kathrin Stoll
- Birth Place Lab, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
| | - Jessie J Wang
- Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Paulomi Niles
- Birth Place Lab, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.,New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY, 10010, USA
| | - Lindsay Wells
- Midwifery Education Program, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada
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22
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Swift EM, Zoega H, Stoll K, Avery M, Gottfreðsdóttir H. Enhanced Antenatal Care: Combining one-to-one and group Antenatal Care models to increase childbirth education and address childbirth fear. Women Birth 2020; 34:381-388. [PMID: 32718800 DOI: 10.1016/j.wombi.2020.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND We designed and implemented a new model of care, Enhanced Antenatal Care (EAC), which offers a combined approach to midwifery-led care with six one-to-one visits and four group sessions. AIM To assess EAC in terms of women's satisfaction with care, autonomy in decision-making, and its effectiveness in lowering childbirth fear. METHODS This was a quasi-experimental controlled trial comparing 32 nulliparous women who received EAC (n=32) and usual antenatal care (n=60). We compared women's satisfaction with care and autonomy in decision-making post-intervention using chi-square test. We administered a Fear of Birth Scale pre- and post-intervention and assessed change in fear of birth in each group using the Cohen's d for effect size. To isolate the effect of EAC, we then restricted this analysis to women who did not attend classes alongside maternal care (n=13 in EAC and n=13 in usual care). FINDINGS Women's satisfaction with care in terms of monitoring their and their baby's health was similar in both groups. Women receiving EAC were more likely than those in usual care to report having received enough information about the postpartum period (75% vs 30%) and parenting (91% vs 55%). Overall, EAC was more effective than usual care in reducing fear of birth (Cohen's d=-0.21), especially among women not attending classes alongside antenatal care (Cohen's d=-0.83). CONCLUSION This study is the first to report findings on EAC and suggests that this novel model may be beneficial in terms of providing education and support, as well as lowering childbirth fear.
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Affiliation(s)
- Emma Marie Swift
- Faculty of Nursing/Department of Midwifery, University of Iceland, Eirberg við Eiríksgötu, 101 Reykjavík, Iceland.
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Sturlugata 8, 101 Reykjavík, Iceland; Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kathrin Stoll
- Division of Midwifery, University of British Columbia, Vancouver, Canada
| | - Melissa Avery
- University of Minnesota, School of Nursing, Minneapolis, MN, USA
| | - Helga Gottfreðsdóttir
- Faculty of Nursing/Department of Midwifery, University of Iceland, Eirberg við Eiríksgötu, 101 Reykjavík, Iceland; Women's Clinic, Landspitali University Hospital, 101 Reykjavik, Iceland
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Zinsser LA, Stoll K, Wieber F, Pehlke-Milde J, Gross MM. Changing behaviour in pregnant women: A scoping review. Midwifery 2020; 85:102680. [PMID: 32151875 DOI: 10.1016/j.midw.2020.102680] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Behaviour change programmes (BCPs) for pregnant women are frequently implemented as part of health promotion initiatives. At present, little is known about the types of behaviour change programmes that are being implemented and whether these programmes are designed and delivered in accordance with the principles of high quality maternity care. In this scoping review, we provide an overview of existing interventions related to behaviour change in pregnancy with a particular emphasis on programmes that include empowerment components to promote autonomy and woman-led decision-making. METHODS A systematic search strategy was applied to check for relevant papers in August 2017 and again in October 2018. RESULTS Thirty studies met the criteria for inclusion. These studies addressed weight management, smoking cessation, general health education, nutrition, physical activity, alcohol consumption and dental health. The main approach was knowledge gain through education. More than half of the studies (n = 17) included three or more aspects of empowerment as part of the intervention. The main aspect used to foster women`s empowerment was skills and competencies. In nine studies midwives were involved, but not as programme leaders. CONCLUSIONS Education for knowledge gain was found to be the prevailing approach in behaviour change programmes. Empowerment aspects were not a specific focus of the behaviour change programmes. This review draws attention to the need to design interventions that empower women, which may be beneficial through their live. As midwives provide maternal healthcare worldwide, they are well-suited to develop, manage, implement or assist in BCPs.
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Affiliation(s)
- Laura A Zinsser
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany; University of British Columbia, Division of Midwifery, Faculty of Medicine, 5950 University Boulevard, Vancouver BC V6T 1Z3, Canada.
| | - Frank Wieber
- Zurich University of Applied Sciences, School of Health Professions, Technikumstrasse 81, Winterthur 8400, Switzerland; University of Konstanz, Department of Psychology, Universitätsstr. 10, Konstanz 78457, Germany.
| | - Jessica Pehlke-Milde
- Zurich University of Applied Sciences, School of Health Professions, Technikumstrasse 81, Winterthur 8400, Switzerland.
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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Sidhu R, Su B, Shapiro KR, Stoll K. Prevalence of and factors associated with burnout in midwifery: A scoping review. Eur J Midwifery 2020; 4:4. [PMID: 33537606 PMCID: PMC7839164 DOI: 10.18332/ejm/115983] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Midwifery care meets the triple aims of health system improvement, i.e. good health outcomes, high client satisfaction, and low per capita costs. Scaling up access to midwifery care is a global priority yet the growth and sustainability of the profession is threatened by high levels of burnout and attrition. This scoping review provides a comprehensive review of the existing literature on burnout in midwifery, with a focus on prevalence, associated factors and potential solutions. METHODS Four electronic databases were searched to locate relevant literature up to July 2019. A total of 1034 articles were identified and reduced to 27 articles that met inclusion criteria. We summarize sample sizes, settings, study designs, burnout measures, prevalence of burnout, associated factors and potential solutions, and recommendations. RESULTS Prevalence of burnout was highest among Australian, Western Canadian and Senegalese midwives and lowest among Dutch and Norwegian midwives. Midwives working in caseload/continuity models reported significantly lower burnout compared to midwives working in other models. We identified 26 organizational and personal factors that were significantly associated with burnout, such as high workload, exposure to traumatic events, and fewer years in practices. Organizational support to improve work-life balance and emotional well-being, as well as more continuing education to raise awareness about burnout and how to cope with it, emerged as common strategies to prevent and address burnout. CONCLUSIONS Burnout is a serious and complex occupational phenomenon. More qualitative research is needed in this area, to better understand the lived experience of burnout.
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Affiliation(s)
- Rawel Sidhu
- Vancouver Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Bowen Su
- Vancouver Fraser Medical Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate R Shapiro
- Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kathrin Stoll
- Division of Midwifery, Department of Family Practice, University of British Columbia, Vancouver, Canada
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Abstract
Background: No studies have examined the frequency of thyroid screening in the Canadian population, and whether thyroid screening and medication use vary by sex, race, income, and preexisting health conditions. Methods: Using data from the 2011, 2012 cycles of the Canadian Community Health Survey, we report rates of thyroid screening among Quebec residents ≥35 (n=7024) and rates of thyroid medication use among Quebec residents ≥35 (n=16,081). We examine variations in medication use and screening by sex, age, race, immigration status, access to a regular doctor, and health conditions that have been linked to thyroid disease. Results: Of the Quebec residents ≥35, 10.3% reported taking thyroid medication and 0.4% reported that the last blood test a physician ordered was to check for a new thyroid condition. Canadian-born residents and those who identified as White reported higher medication use and screening rates, compared to immigrants and those who identified as visible minorities. Racial disparities were especially pronounced, with White Quebec residents reporting three times greater odds of thyroid screening than visible minorities. The strongest predictors of both thyroid medication use and screening were access to a regular doctor. Despite women being eight times more likely to suffer from thyroid disease, women were not significantly more likely to be screened, compared to men (odds ratio=1.38, 95% confidence interval: 0.74–2.60). Discussion: Strategies are needed to decrease disparities in thyroid screening and medication use. Interventions that target health systems (e.g., increasing physician supply), providers (continuing professional education modules about thyroid disease for family physicians), and recipients of care (multilanguage public awareness campaigns and posters at walk-in clinics that describe common symptoms of different thyroid disorders) should be implemented and tested.
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Affiliation(s)
- Kathrin Stoll
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019. [PMID: 31182118 DOI: 10.1186/s12978-019-0729-2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study. METHODS Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. RESULTS Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. CONCLUSION This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA.,Department of Midwifery, Bastyr University, Seattle, WA, USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
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Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, McLemore M, Cadena M, Nethery E, Rushton E, Schummers L, Declercq E. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health 2019; 16:77. [PMID: 31182118 PMCID: PMC6558766 DOI: 10.1186/s12978-019-0729-2] [Citation(s) in RCA: 330] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)–US study. Methods Our multi-stakeholder team distributed an online cross-sectional survey to capture lived experiences of maternity care in diverse populations. Patient-designed items included indicators of verbal and physical abuse, autonomy, discrimination, failure to meet professional standards of care, poor rapport with providers, and poor conditions in the health system. We quantified the prevalence of mistreatment by race, socio-demographics, mode of birth, place of birth, and context of care, and describe the intersectional relationships between these variables. Results Of eligible participants (n = 2700), 2138 completed all sections of the survey. One in six women (17.3%) reported experiencing one or more types of mistreatment such as: loss of autonomy; being shouted at, scolded, or threatened; and being ignored, refused, or receiving no response to requests for help. Context of care (e.g. mode of birth; transfer; difference of opinion) correlated with increased reports of mistreatment. Experiences of mistreatment differed significantly by place of birth: 5.1% of women who gave birth at home versus 28.1% of women who gave birth at the hospital. Factors associated with a lower likelihood of mistreatment included having a vaginal birth, a community birth, a midwife, and being white, multiparous, and older than 30 years. Rates of mistreatment for women of colour were consistently higher even when examining interactions between race and other maternal characteristics. For example, 27.2% of women of colour with low SES reported any mistreatment versus 18.7% of white women with low SES. Regardless of maternal race, having a partner who was Black also increased reported mistreatment. Conclusion This is the first study to use indicators developed by service users to describe mistreatment in childbirth in the US. Our findings suggest that mistreatment is experienced more frequently by women of colour, when birth occurs in hospitals, and among those with social, economic or health challenges. Mistreatment is exacerbated by unexpected obstetric interventions, and by patient-provider disagreements. Electronic supplementary material The online version of this article (10.1186/s12978-019-0729-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Tanya Khemet Taiwo
- University of California Davis School of Medicine, Sacramento, California, USA.,Department of Midwifery, Bastyr University, Seattle, WA, USA
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco and the Institute for Global Health Sciences, California, USA
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University, Corvallis, Oregon, USA
| | | | - Monica McLemore
- Department of Family Health Care Nursing and ANSIRH Bixby Center for Global Reproductive Health, University of California, San Francisco, USA
| | | | - Elizabeth Nethery
- School of Population & Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eleanor Rushton
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver (Canada), E416 Shaughnessy (Mailbox 80), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Laura Schummers
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Eugene Declercq
- School of Public Health, Boston University, Massachusetts, Boston, USA
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Weeks FH, Sadler M, Stoll K. Preference for caesarean attitudes toward birth in a Chilean sample of young adults. Women Birth 2019; 33:e159-e165. [PMID: 30992177 DOI: 10.1016/j.wombi.2019.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/18/2019] [Accepted: 03/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide. AIM To identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures. METHODS An online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference. FINDINGS Among eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9-14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1-2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0-3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0-6.8) were associated with caesarean preference. DISCUSSION Preference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth. CONCLUSIONS Patient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.
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Affiliation(s)
- Fiona H Weeks
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health. 1 W. Wilson St., Madison, WI, 53704, United States.
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Universidad Adolfo Ibáñez, Diagonal Las Torres, Peñalolén, Santiago, 2640, Chile.
| | - Kathrin Stoll
- Birth Place Lab., University of British Columbia, BC Women's Hospital Shaughnessy Building E418 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
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Vedam S, Stoll K, McRae DN, Korchinski M, Velasquez R, Wang J, Partridge S, McRae L, Martin RE, Jolicoeur G. Patient-led decision making: Measuring autonomy and respect in Canadian maternity care. Patient Educ Couns 2019; 102:586-594. [PMID: 30448044 DOI: 10.1016/j.pec.2018.10.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 09/23/2018] [Accepted: 10/26/2018] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The Changing Childbirth in British Columbia study explored women's preferences and experiences of maternity care, including women's role in decision-making. METHODS Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers. RESULTS A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores. CONCLUSION Women's autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women's ability for self-determination. PRACTICE IMPLICATIONS If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada; School of Medicine, University of Sydney, Australia.
| | - Kathrin Stoll
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daphne N McRae
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mo Korchinski
- Women In 2 Healing, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Raquel Velasquez
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessie Wang
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Partridge
- Birth Place Lab, Department of Family Practice and Midwifery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lorna McRae
- Access Midwifery and Family Care, Victoria, British Columbia, Canada
| | - Ruth Elwood Martin
- Women In 2 Healing, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
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Lefebvre K, Wild J, Stoll K, Vedam S. Through the resident lens: examining knowledge and attitudes about midwifery among physician trainees. J Interprof Care 2018:1-10. [PMID: 30415589 DOI: 10.1080/13561820.2018.1543258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 10/27/2022]
Abstract
Interprofessional collaboration optimizes maternal-newborn outcomes and satisfaction with care. Since 2002, midwives have provided an increasing proportion of maternity care in British Columbia (BC). Midwives often collaborate with and/or refer to physicians; but no study to date has explored Canadian medical trainees' exposure to, knowledge of, and attitudes towards midwifery practice. We designed an online cross-sectional questionnaire that included a scale to measure attitudes towards midwifery (13 items) and residents' knowledge of midwifery (94 items across 5 domains). A multi-disciplinary expert panel rated each item for importance, relevance, and clarity. The survey was distributed to family medicine (n = 338) and obstetric (n = 40) residents in BC. We analyzed responses from 114 residents. Residents with more favourable exposures to midwifery during their education had significantly more positive attitudes towards midwives (rs = 0.32, p = 0.007). We also found a significant positive correlation between residents' attitudes towards midwifery and four of five knowledge domains: scope of practice (rs = 0.41, p < 0.001); content of education (rs = 0.30, p = 0.002), equipment midwives carry to home births (rs = 0.30, p = 0.004) and tests that midwives can order (rs = 0.39, p < 0.001). The most unfavourable exposures were observing interprofessional conversations (66.2%), and providing inpatient consultations for midwives (61.4%). Findings suggest increased interprofessional education may foster improved midwife-physician collaboration. Abbreviations: BC - British Columbia; UBC - University of British Columbia.
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Affiliation(s)
| | - Jennifer Wild
- a Department of Family Practice , Vancouver , Canada
| | - Kathrin Stoll
- b Divion of Midwifery at BC Women's Hospital, Department of Family Practice, Faculty of Medicine , University of British Columbia , Vancouver , Canada
| | - Saraswathi Vedam
- b Divion of Midwifery at BC Women's Hospital, Department of Family Practice, Faculty of Medicine , University of British Columbia , Vancouver , Canada
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Stoll K, Edmonds J, Sadler M, Thomson G, McAra-Couper J, Swift EM, Malott A, Streffing J, Gross MM, Downe S. A cross-country survey of attitudes toward childbirth technologies and interventions among university students. Women Birth 2018; 32:231-239. [PMID: 30150150 DOI: 10.1016/j.wombi.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PROBLEM & AIM Cultural beliefs that equate birth technology with progress, safety and convenience contribute to widespread acceptance of childbirth technology and interventions. Little is known about attitudes towards childbirth technology and interventions among the next generation of maternity care users and whether attitudes vary by country, age, gender, childbirth fear, and other factors. METHODS Data were collected via online survey in eight countries. Students who had never had children, and who planned to have at least one child were eligible to participate. FINDINGS The majority of participants (n=4569) were women (79.3%), and the median age was 22 years. More than half of students agreed that birth technology makes birth easier (55.8%), protects babies from harm (49.1%) and that women have a right to choose a medically non-indicated cesarean (50.8%). Respondents who had greater acceptance of childbirth technology and interventions were from countries with higher national caesarean birth rates, reported higher levels of childbirth fear, and were more likely to report that visual media or school-based education shaped their attitudes toward birth. Positive attitudes toward childbirth technology and interventions were also associated with less confidence in knowledge of birth, and more common among younger and male respondents. DISCUSSION/CONCLUSION Educational strategies to teach university students about pregnancy and birth in ways that does not frighten them and promotes critical reflection about childbirth technology are needed. This is especially true in countries with high rates of interventions that reciprocally shape culture norms, attitudes, and expectations.
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Affiliation(s)
- Kathrin Stoll
- Birth Place Lab, University of British Columbia, BC Women's Hospital Shaughnessy Building E418 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Joyce Edmonds
- Connell School of Nursing, Boston College, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Adolfo Ibáñez University, Diagonal Las Torres 2640, Peñalolén, Santiago, Chile.
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Judith McAra-Couper
- Centre for Midwifery & Women's Health Research, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Emma M Swift
- Department of Midwifery, Faculty of Nursing-University of Iceland, Iceland.
| | - Anne Malott
- Midwifery Education Program, McMaster University, 1280 Main St. West, MDCL 2nd Floor, Hamilton, Ontario, Canada.
| | - Joana Streffing
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
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Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth 2018; 45:7-18. [PMID: 29057487 DOI: 10.1111/birt.12316] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB. METHODS Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies. RESULTS Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours). CONCLUSIONS Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Department of Nursing, University of Iceland, Reykjavík, Iceland
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Island Medical Program, Victoria, Canada
| | - Elizabeth Nethery
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, Cheyney M, Fisher T, Butt E, Yang YT, Powell Kennedy H. Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS One 2018; 13:e0192523. [PMID: 29466389 PMCID: PMC5821332 DOI: 10.1371/journal.pone.0192523] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/16/2018] [Indexed: 12/02/2022] Open
Abstract
METHODS Our multidisciplinary team examined published regulatory data to inform a 50-state database describing the environment for midwifery practice and interprofessional collaboration. Items (110) detailed differences across jurisdictions in scope of practice, autonomy, governance, and prescriptive authority; as well as restrictions that can affect patient safety, quality, and access to maternity providers across birth settings. A nationwide survey of state regulatory experts (n = 92) verified the 'on the ground' relevance, importance, and realities of local interpretation of these state laws. Using a modified Delphi process, we selected 50/110 key items to include in a weighted, composite Midwifery Integration Scoring (MISS) system. Higher scores indicate greater integration of midwives across all settings. We ranked states by MISS scores; and, using reliable indicators in the CDC-Vital Statistics Database, we calculated correlation coefficients between MISS scores and maternal-newborn outcomes by state, as well as state density of midwives and place of birth. We conducted hierarchical linear regression analysis to control for confounding effects of race. RESULTS MISS scores ranged from lowest at 17 (North Carolina) to highest at 61 (Washington), out of 100 points. Higher MISS scores were associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, and breastfeeding, and significantly lower rates of cesarean, preterm birth, low birth weight infants, and neonatal death. MISS scores also correlated with density of midwives and access to care across birth settings. Significant differences in newborn outcomes accounted for by MISS scores persisted after controlling for proportion of African American births in each state. CONCLUSION The MISS scoring system assesses the level of integration of midwives and evaluates regional access to high quality maternity care. In the United States, higher MISS Scores were associated with significantly higher rates of physiologic birth, less obstetric interventions, and fewer adverse neonatal outcomes.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- University of Sydney, School of Medicine, Sydney, Australia
| | - Kathrin Stoll
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marian MacDorman
- Maryland Population Research Center, University of Maryland, College Park, Maryland, United States of America
| | - Eugene Declercq
- School of Public Health, Boston University, Boston, Massachusetts, United States of America
| | - Renee Cramer
- Law, Politics and Society, Drake University, Des Moines, Iowa, United States of America
| | - Melissa Cheyney
- Department of Anthropology, Oregon State University College of Liberal Arts, Corvallis, Oregon, United States of America
| | - Timothy Fisher
- Department of Obstetrics and Gynecology, Geisel School of Medicine, Dartmouth University, Lebanon, New Hampshire, United States of America
| | - Emma Butt
- Birth Place Lab, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Y. Tony Yang
- Health Administration and Policy, George Mason University, Fairfax, Virginia, United States of America
| | - Holly Powell Kennedy
- Department of Midwifery, Yale School of Nursing, Orange, Connecticut, United States of America
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Stoll K, Fairbrother N, Thordarson DS. Childbirth Fear: Relation to Birth and Care Provider Preferences. J Midwifery Womens Health 2018; 63:58-67. [PMID: 29364575 DOI: 10.1111/jmwh.12675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received. METHODS A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40-item scale that measures 9 dimensions of childbirth fear. RESULTS Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients. DISCUSSION At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth.
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Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, Jolicoeur G. The Mothers on Respect (MOR) index: measuring quality, safety, and human rights in childbirth. SSM Popul Health 2017; 3:201-210. [PMID: 29349217 PMCID: PMC5768993 DOI: 10.1016/j.ssmph.2017.01.005] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/17/2017] [Accepted: 01/18/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Abuse of human rights in childbirth are documented in low, middle and high resource countries. A systematic review across 34 countries by the WHO Research Group on the Treatment of Women During Childbirth concluded that there is no consensus at a global level on how disrespectful maternity care is measured. In British Columbia, a community-led participatory action research team developed a survey tool that assesses women's experiences with maternity care, including disrespect and discrimination. METHODS A cross-sectional survey was completed by women of childbearing age from diverse communities across British Columbia. Several items (31/130) assessed characteristics of their communication with care providers. We assessed the psychometric properties of two versions of a scale (7 and 14 items), among women who described experiences with a single maternity provider (n=2514 experiences among 1672 women). We also calculated the proportion and selected characteristics of women who scored in the bottom 10th percentile (those who experienced the least respectful care). RESULTS To demonstrate replicability, we report psychometric results separately for three samples of women (S1 and S2) (n=2271), (S3, n=1613). Analysis of item-to-total correlations and factor loadings indicated a single construct 14-item scale, which we named the Mothers on Respect index (MORi). Items in MORi assess the nature of respectful patient-provider interactions and their impact on a person's sense of comfort, behavior, and perceptions of racism or discrimination. The scale exhibited good internal consistency reliability. MORi- scores among these samples differed by socio-demographic profile, health status, experience with interventions and mode of birth, planned and actual place of birth, and type of provider. CONCLUSION The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Nicholas Rubashkin
- Department of Global Health Sciences, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA
- Department of Obstetrics and Gynecology, University of California San Francisco, Mission Hall Building, 550 - 16th Street, 3rd Floor, San Francisco, CA 94158, USA
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia, 5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Zoe Miller-Vedam
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Hermine Hayes-Klein
- Human Rights in Childbirth, 6312 SW Capitol Highway St, 234 Portland, OR 97239, USA
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, 2-175 E. 15th Avenue, Vancouver, BC, Canada V5T 2P6
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Fairbrother N, Thordarson DS, Stoll K. Fine tuning fear of childbirth: the relationship between Childbirth Fear Questionnaire subscales and demographic and reproductive variables. J Reprod Infant Psychol 2017. [DOI: 10.1080/02646838.2017.1396300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Nichole Fairbrother
- Department of Psychiatry/Island Medical Program, University of British Columbia, Victoria, B.C., Canada
| | - Dana S. Thordarson
- Department of Family Practice, University of British Columbia, Vancouver, B.C., Canada
| | - Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, B.C., Canada
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Vedam S, Rossiter C, Homer CSE, Stoll K, Scarf VL. The ResQu Index: A new instrument to appraise the quality of research on birth place. PLoS One 2017; 12:e0182991. [PMID: 28797127 PMCID: PMC5552354 DOI: 10.1371/journal.pone.0182991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth. Study design The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability. Results A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness. Conclusion The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.
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Affiliation(s)
- Saraswathi Vedam
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Caroline S. E. Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Kathrin Stoll
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Vanessa L. Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- * E-mail:
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McRae DN, Muhajarine N, Stoll K, Mayhew M, Vedam S, Mpofu D, Janssen PA. Corrigendum to "Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care" [SSM - Population Health 2 (2016) 182-193]. SSM Popul Health 2017; 3:817. [PMID: 29988861 PMCID: PMC6033258 DOI: 10.1016/j.ssmph.2017.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Daphne N McRae
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Saraswathi Vedam
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Deborah Mpofu
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5.,Saskatoon Health Region, 701 Queen St., Saskatoon, Sask., Canada S7K 0M7
| | - Patricia A Janssen
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
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Abstract
BACKGROUND Sociocultural childbirth representations can influence the perceptions of childbirth negatively. In this paper we report on a survey study to explore the factors associated with negative impressions of childbirth in a North-West England University student sample. We also explored whether different sources and perceptions of childbirth information were linked to fear of childbirth. METHODS All students received a survey link via an online messaging board and/or direct e-mail. Female students who were 18-40 years of age and childless (but planned to have children in the future) were invited to participate. Demographics, birth preferences, a fear of birth and general anxiety measures were included as well as questions about what sources of information shaped students' attitudes toward pregnancy and birth (i.e. visual/written media, experiences of friends/family members, school-based education and other) and impressions of birth from these sources (i.e. positive, negative, both positive and negative and not applicable). RESULTS Eligible students (n = 276) completed the online questionnaire. The majority were Caucasian (87%) with a mean age of 22.6 years. Ninety-two students (33.3%) reported negative childbirth impressions through direct or vicarious sources. Students with negative birth impressions were significantly more likely to report higher fear of birth scores. Negatively perceived birth stories of friends/family members, and mixed perceptions of visual media representations of birth were associated with higher fear of birth scores. Having witnessed a birth first-hand and describing the experience as amazing was linked to lower fear scores. CONCLUSION First-hand observations of birth, especially positive experiences, had implications for salutary outcomes. Negative or conflicting perceptions of vicarious experiences were associated with increased levels of childbirth fear. While further research is needed, these insights suggest a need for positive birth stories and messages to be disseminated to mitigate any negative effects of indirect accounts.
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Affiliation(s)
- Gill Thomson
- a Maternal and Infant Nutrition and Nurture Unit (MAINN) , University of Central Lancashire , Preston , Lancashire , England
| | - Kathrin Stoll
- b Faculty of Medicine , School of Population and Public Health, University of British Columbia , Vancouver , BC , Canada
| | - Soo Downe
- c Research in Childbirth and Health Unit (ReaCH) , University of Central Lancashire , Preston , Lancashire , England
| | - Wendy A Hall
- d School of Nursing , University of British Columbia , Vancouver , BC , Canada
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Swift EM, Gottfredsdottir H, Zoega H, Gross MM, Stoll K. Opting for natural birth: A survey of birth intentions among young Icelandic women. Sexual & Reproductive Healthcare 2017; 11:41-46. [DOI: 10.1016/j.srhc.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Vedam S, Stoll K, Martin K, Rubashkin N, Partridge S, Thordarson D, Jolicoeur G. The Mother's Autonomy in Decision Making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLoS One 2017; 12:e0171804. [PMID: 28231285 PMCID: PMC5322919 DOI: 10.1371/journal.pone.0171804] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To develop and validate a new instrument that assesses women's autonomy and role in decision making during maternity care. DESIGN Through a community-based participatory research process, service users designed, content validated, and administered a cross-sectional quantitative survey, including 31 items on the experience of decision-making. SETTING AND PARTICIPANTS Pregnancy experiences (n = 2514) were reported by 1672 women who saw a single type of primary maternity care provider in British Columbia. They described care by a midwife, family physician or obstetrician during 1, 2 or 3 maternity care cycles. We conducted psychometric testing in three separate samples. MAIN OUTCOME MEASURES We assessed reliability, item-to-total correlations, and the factor structure of the The Mothers' Autonomy in Decision Making (MADM) scale. We report MADM scores by care provider type, length of prenatal appointments, preferences for role in decision-making, and satisfaction with experience of decision-making. RESULTS The MADM scale measures a single construct: autonomy in decision-making during maternity care. Cronbach alphas for the scale exceeded 0.90 for all samples and all provider groups. All item-to-total correlations were replicable across three samples and exceeded 0.7. Eigenvalue and scree plots exhibited a clear 90-degree angle, and factor analysis generated a one factor scale. MADM median scores were highest among women who were cared for by midwives, and 10 or more points lower for those who saw physicians. Increased time for prenatal appointments was associated with higher scale scores, and there were significant differences between providers with respect to average time spent in prenatal appointments. Midwifery care was associated with higher MADM scores, even during short prenatal appointments (<15 minutes). Among women who preferred to lead decisions around their care (90.8%), and who were dissatisfied with their experience of decision making, MADM scores were very low (median 14). Women with physician carers were consistently more likely to report dissatisfaction with their involvement in decision making. DISCUSSION The Mothers Autonomy in Decision Making (MADM) scale is a reliable instrument for assessment of the experience of decision making during maternity care. This new scale was developed and content validated by community members representing various populations of childbearing women in BC including women from vulnerable populations. MADM measures women's ability to lead decision making, whether they are given enough time to consider their options, and whether their choices are respected. Women who experienced midwifery care reported greater autonomy than women under physician care, when engaging in decision-making around maternity care options. Differences in models of care, professional education, regulatory standards, and compensation for prenatal visits between midwives and physicians likely affect the time available for these discussions and prioritization of a shared decision making process. CONCLUSION The MADM scale reflects person-driven priorities, and reliably assesses interactions with maternity providers related to a person's ability to lead decision-making over the course of maternity care.
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Affiliation(s)
- Saraswathi Vedam
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- * E-mail:
| | - Kathrin Stoll
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Martin
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Nicholas Rubashkin
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, United States of America
| | - Sarah Partridge
- Residency Program, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dana Thordarson
- Birth Place Research Lab, Division of Midwifery, University of British Columbia Vancouver, British Columbia, Canada
| | - Ganga Jolicoeur
- Midwives Association of British Columbia, Vancouver, British Columbia, Canada
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McRae DN, Muhajarine N, Stoll K, Mayhew M, Vedam S, Mpofu D, Janssen PA. Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care. SSM Popul Health 2016; 2:182-193. [PMID: 29349139 PMCID: PMC5757823 DOI: 10.1016/j.ssmph.2016.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/17/2015] [Accepted: 01/11/2016] [Indexed: 11/15/2022] Open
Abstract
This scoping review investigates if, over the last 25 years in high resource countries, midwives' patients of low socioeconomic position (SEP) were at more or less risk of adverse infant birth outcomes compared to physicians' patients. Reviewers identified 917 records in a search of 12 databases, grey literature, and citation lists. Thirty-one full documents were assessed and nine studies met inclusion criteria. Eight studies were assessed as moderate in quality; one study was given a weak rating. Of the moderate quality studies, the majority found no statistical difference in outcomes according to model of care for preterm birth, low or very low birth weight, or NICU admission. No study reported a statistically significant difference for small for gestational age birth (2 studies), or mean or low Apgar score (4 studies). However, one study found a reduced risk of preterm birth (AOR=0.70, p<0.01), and heavier mean infant birth weight (3325 g vs. 3282 g, p<0.01) for midwifery patients. Another study reported lower risk of low (RR=0.59, 95% CI: 0.46, 0.73) and very low birthweight (RR=0.44, 95% CI: 0.23, 0.85) for midwifery care. And, a third study reported a decrease in stays (1-3 days) in NICU (Adjusted Risk Difference=-1.8, 95% CI: -3.9, 0.2) for midwifery patients, though no overall difference in NICU admission of any duration. Other studies reported significant differences favoring midwifery care for mean birth weight (3598 g vs. 3407.3 g, p<0.05; 3233 g vs. 3089 g, p<0.05; 2 studies) and very low birth weight (OR=0.35, 95% CI:0.1, 0.9), for sub-groups within the larger study populations. This scoping review documented heterogeneity in study designs and analytical methods, inconsistent findings, moderate methodological quality, and lack of currency. There is a need for new studies to definitively establish if and how a midwifery-led model of care influences birth outcomes for women of low SEP.
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Affiliation(s)
- Daphne N. McRae
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Maureen Mayhew
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Saraswathi Vedam
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
| | - Deborah Mpofu
- Community Health and Epidemiology, University of Saskatchewan, Health Science Building, 107 Wiggins Rd., Saskatoon, Sask., Canada S7N 5E5
- Saskatoon Health Region, 701 Queen St., Saskatoon, Sask., Canada S7K 0M7
| | - Patricia A. Janssen
- UBC Midwifery, University of British Columbia, Suite 320-5950 University Boulevard, Vancouver, BC, Canada V6T 1Z3
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McRae D, Stoll K, Janssen P. Methodological Challenges in a Manitoba Study of Provider Type and Perinatal Outcomes Using Hospital Discharge Data. Birth 2016; 43:268-9. [PMID: 27534514 DOI: 10.1111/birt.12243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Daphne McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kathrin Stoll
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patricia Janssen
- Co-theme Lead, Maternal Child Health, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Stoll K, Hauck Y, Downe S, Edmonds J, Gross MM, Malott A, McNiven P, Swift E, Thomson G, Hall WA. Cross-cultural development and psychometric evaluation of a measure to assess fear of childbirth prior to pregnancy. Sexual & Reproductive Healthcare 2016; 8:49-54. [DOI: 10.1016/j.srhc.2016.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 02/13/2016] [Accepted: 02/15/2016] [Indexed: 01/04/2023]
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Vedam S, Stoll K, Jolicouer G, Martin K, Korchinski M, Velasquez R. O-OBS-RM-112 Patient-led Decision Making: Measuring Autonomy and Respect in Canadian Maternity Care. Journal of Obstetrics and Gynaecology Canada 2016. [DOI: 10.1016/j.jogc.2016.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fulton C, Stoll K, Thordarson D. Bedside resuscitation of newborns with an intact umbilical cord: Experiences of midwives from British Columbia. Midwifery 2016; 34:42-46. [DOI: 10.1016/j.midw.2016.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/26/2022]
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Bonzon M, Karch A, Stoll K, Grylka-Bäschlin S, Gross MM. Vaginal mode of birth after previous caesarean section versus elective repeat caesarean section: factors associated with women's preferences in Western Switzerland. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Grzybowski S, Fahey J, Lai B, Zhang S, Aelicks N, Leung BM, Stoll K, Attenborough R. The safety of Canadian rural maternity services: a multi-jurisdictional cohort analysis. BMC Health Serv Res 2015; 15:410. [PMID: 26400830 PMCID: PMC4581105 DOI: 10.1186/s12913-015-1034-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/04/2015] [Indexed: 08/29/2023] Open
Abstract
Background Small Canadian rural maternity services are struggling to maintain core staffing and remain open. Existing evidence states that having to travel to access maternity services is associated with adverse outcomes. The goal of this study is to systematically examine rural maternal and newborn outcomes across three Canadian provinces. Methods We analyzed maternal newborn outcomes data through provincial perinatal registries in British Columbia, Alberta and Nova Scotia for deliveries that occurred between April 1st 2003 and March 31st 2008. All births were allocated to maternity service catchments based on the residence of the mothers. Individual catchments were stratified to service levels based on distance to access intrapartum maternity services or the model of maternity services available in the community. The amalgamation of analyses from each jurisdiction involved comparison of logistic regression effect estimates. Results The number of singleton births included in the study is 150,797. Perinatal mortality is highest in communities that are greater than 4 h from maternity services overall. Rates of prematurity at less than 37 weeks gestation are higher for rural women without local access to services. Caesarean section rates are highest in communities served by general surgical models. Conclusion Composite analysis of data from three Canadian provinces provides the strongest evidence to date demonstrating that we need to sustain small community maternity services with and without caesarean section capability.
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Affiliation(s)
- Stefan Grzybowski
- University of British Columbia, 300-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
| | - John Fahey
- Reproductive Care Program of Nova Scotia, Suite 700-5991 Spring Garden Rd, Halifax, NS, B3H 1Y6, Canada.
| | - Barbara Lai
- University of British Columbia, 300-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
| | - Sharon Zhang
- Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada.
| | - Nancy Aelicks
- Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada.
| | - Brenda M Leung
- Alberta Perinatal Health Program, Alberta Health Services, 10030-107 Street NW Edmonton, Alberta, T5J 3E4, Canada.
| | - Kathrin Stoll
- School of Population & Public Health, UBC, Vancouver, Canada.
| | - Rebecca Attenborough
- Reproductive Care Program of Nova Scotia, Suite 700-5991 Spring Garden Rd, Halifax, NS, B3H 1Y6, Canada.
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Abstract
BACKGROUND The Childbirth Self-Efficacy Inventory (CBSEI) is an instrument that measures women's perceived self-efficacy towards labour. It is used in 9 countries, a 32-item short form (CBSEI-C32) in 4 countries. German versions of the CBSEI and the CBSEI-C32 have not been developed thus far. METHODS A forward-backward translation was performed, followed by administration of both instruments to a sample of 155 participants of antenatal classes. Pregnant women answered questions regarding their medical history and user-friendliness of the instruments. 80 respondents completed the CBSEI, 75 the CBSEI-C32. Reliability via Cronbach alpha was calculated for the 4 subscales of the CBSEI and the 2 subscales of the short form. Validity was only assessed for the 2 scales of the CBSEI-C32 because all women (n=155) completed this instrument. RESULTS 2 Cronbach alpha values were greater than 0.74 (adequate), the others greater than 0.80 (good). Most of the factors of the CBSEI-C32 (75%) were above ≥0.5. Calculation of the item-to-total-correlations revealed that the exclusion of 3 items might be indicated for the German version. The short form showed a significant association between level of education and perceived self-efficacy (p=0.01). RESULTS in the area of user-friendliness were more encouraging for the CBSEI-C32 than for the CBSEI. CONCLUSION The German version of the CBSEI is a useful instrument which may improve advice and counselling during prenatal care in Germany.
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Affiliation(s)
- G Schmidt
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
| | - K Stoll
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
| | - B Jäger
- Klinik für Psychosomatik und Psychotherapie, Medizinische Hochschule Hannover, Hannover
| | - M M Gross
- AG Hebammenwissenschaft, Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover
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