Validation of the Childbirth Attitudes Questionnaire in Greek and psychosocial characteristics of pregnant women with fear of childbirth

BackgroundFear of childbirth has been found to be a factor that influences women's decision about their choice of delivery. The investigation of psychological factors that relate to fear of childbirth as well as the validation of the Childbirth Attitudes Questionnaire (CAQ) can help identify pregnant women with high fear of childbirth.AimThis study aimed to (a) translate and validate the Childbirth Attitude Questionnaire in Greek and (b) explore how fear of childbirth was related to childbirth self-efficacy, state anxiety, depression, neuroticism, self-esteem and optimism.Methods145 nulliparous pregnant women, in late pregnancy, attending routine antenatal visit in a private maternity clinic participated. All participants completed the CAQ (fear of childbirth) and other self-report questionnaires that measured childbirth self-efficacy, self-esteem, optimism, neuroticism, state anxiety and depressive symptomatology. Factor structure was investigated using principal axis factoring. Cronbach's α was used to measure internal consistency reliability. Pearson's correlation coefficients were calculated between all study variables, followed by multiple linear regression.FindingsThe factor analysis suggested the existence of one-factor structure. Construct validity was confirmed by computing correlations between the CAQ and childbirth self-efficacy, self-esteem and optimism. Multivariate analysis showed that childbirth self-efficacy, self-esteem and optimism were negatively and significantly associated with fear of childbirth.Conclusion and implications for practiceThe Greek version of the CAQ is a reliable and valid measure. The clinical use of CAQ may enable midwives and other health care professionals to identify pregnant women with low childbirth confidence and to provide information and support.     

Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study

ABSTRACT

This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.     

Women’s childbirth experience emphasizing own capacity and safety: A cross-sectional Rwandan study

Problem and aimWomen’s childbirth experience is central when assessing intrapartum care quality. This study accordingly measures women’s childbirth experience in Rwandan health facilities, focusing on own capacity and perceived safety.MethodsA cross-sectional health facility-based study was conducted December 2014 to January 2015 in Kigali City and the Northern Province. Childbirth experience was assessed before discharge using an overall assessment and two subscales, Own capacity and Perceived safety, of the Childbirth Experience Questionnaire, with high scores reflecting a good experience. The questionnaire was translated from English into Kinyarwanda. Reliability was tested using Cronbach’s alpha; and mean scores between groups were compared using Mann–Whitney U test.FindingsAll invited women (n = 817) agreed to participate after informed consent. Mean age was 27.8 years and 63.6% were multiparous. A majority of women (82.3%) reported an overall positive childbirth experience (≥8 out of 10). Cronbach’s alpha indicated good reliability for Own capacity (0.78) and Perceived safety (0.76). In both subscales multiparous women had higher mean scores than primiparous, married women scored higher than unmarried, older women (>35) scored higher than younger (<35), and women with higher level of education scored higher than those with lower level. Women with HIV scored lower on perceived safety.ConclusionA majority of the women reported a positive overall childbirth experience. Own capacity and perceived safety are important dimensions of childbirth experience and should be addressed in building high-quality intrapartum care. Further research is needed and should include exploration of specific groups.     

Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

IssueFear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.AimTo conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.MethodsA meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.FindingsOne overarching theme “Ownership of Childbirth” and three analytical themes “Facing the fear”, “Feeling empowered”, “Managing the fear with a sense of security” were generated through the synthesis. There were no studies outside of Scandinavia located.DiscussionThis meta-synthesis provides a new way to describe the process of moving from fear to “Ownership of childbirth”. The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.ConclusionThese findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.     

An emerging model of maternity care: Smartphone,midwife, doctor?

BackgroundMobile technology in the form of the smartphone is widely used, particularly in pregnancy and they are an increasing and influential source of information.AimTo describe the diverse nature of pregnancy related applications (apps) for the smartphone and to flag that these apps can potentially affect maternity care and should be considered in future planning of care provision.MethodsThe 2 smartphone platforms, Apple and Android, were searched for pregnancy related apps and reviewed for their purpose and popularity.FindingsiTunes and Google Play returned 1059 and 497 pregnancy related apps respectively. Forty percent of the apps were informative, 13% interactive, 19% had features of a medical tool and 11% were social media apps. By far the most popular apps, calculated as the number of reviews multiplied by average reviewer rating, were those with interactive features.DiscussionThe popularity of pregnancy-related apps could indicate a shift towards patient empowerment within maternity care provision. The traditional model of ‘shared maternity care’ needs to accommodate electronic devices into its functioning. Reliance on healthcare professionals may be reduced by the availability of interactive and personalised information delivered via a smartphone. This combined with the fact that smartphones are widely used by many women of childbearing age, has the potential to modify maternity care and experiences of pregnancy. Therefore it is important that healthcare professionals and policy-makers are more aware of these new developments, which are likely to influence healthcare and alter health-seeking behaviour. In addition healthcare professionals need to consider whether to discuss the use of apps in pregnancy with the women in their care.     

Self reported fear of childbirth and its association with women's birth experience and mode of delivery: A longitudinal population-based study

ObjectiveTo explore fear of childbirth (FOC) during pregnancy and one year after birth and its association to birth experience and mode of delivery.DesignA longitudinal population-based study.PopulationPregnant women who were listed for a routine ultrasound at three hospitals in the middle-north part of Sweden.MethodDifferences between women who reported FOC and who did not were calculated using risk ratios with a 95% confidence interval. In order to explain which factors were most strongly associated to suffer from FOC during pregnancy and one year after childbirth, multivariate logistic regression analyses were used.ResultsFOC during pregnancy in multiparous women was associated with a previous negative birth experience (RR 5.1, CI 2.5–10.4) and a previous emergency caesarean section (RR 2.5, CI 1.2–5.4). Associated factors for FOC one year after childbirth were: a negative birth experience (RR 10.3, CI 5.1–20.7), fear of childbirth during pregnancy (RR 7.1, CI 4.4–11.7), emergency caesarean section (RR 2.4, CI 1.2–4.5) and primiparity (RR 1.9, CI 1.2–3.1).ConclusionFOC was associated with negative birth experiences. Women still perceived the birth experience as negative a year after the event. Women's perception of the overall birth experience as negative seems to be more important for explaining subsequent FOC than mode of delivery. Maternity care should focus on women's experiences of childbirth. Staff at antenatal clinics should ask multiparous women about their previous experience of childbirth. So that FOC is minimized, research on factors that create a positive birth experience for women is required.     

The influence and meaning of the birth environment for nulliparous women at a hospital-based labour ward in Sweden: An ethnographic study

BackgroundLabour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors.AimTo explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward.MethodsFive months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a ‘Regular’ birthing room (n = 8) or a specially designed, ‘New room’ (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process.FindingsThe analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women’s agency was facilitated.ConclusionInstitutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women’s needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women’s sense of agency.     

Childbirth experience in women participating in a continuity of midwifery care project

BackgroundContinuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care.AimThe aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden.MethodsAn experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences.ResultA total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support.ConclusionsThe results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.     

A cross-sectional study to determine utility of childbirth fear screening in maternity practice – An Australian perspective

BackgroundLow intensity anxiety in pregnancy is normal however high levels of fear affect between 20% and 25% of women, with around 10% suffering severe levels. Research from Scandinavian countries includes women with severe levels of fear, with little work undertaken in Australia. This paper explores predictors of fear and the relative benefits of screening women for childbirth fear at high or severe levels.MethodA secondary analysis of data collected for the BELIEF study was conducted to determine differences for demographic, psycho-social and obstetric factors in women with severe fear (W-DEQ ≥85, n = 68) compared to women with less or no fear (n = 1318). Women with severe fear (W-DEQ ≥85, n = 68) were also compared to those with high fear scores (W-DEQ ≥66–84, n = 265). Logistic regression modelling was used to ascertain if screening for high or severe levels of fear is most optimal.Results1386 women completed the W-DEQ. There were no differences on demographic variables between women with severe or high fear. Depression symptoms, decisional conflict and low self-efficacy predicted high and severe fear levels. Nulliparity was a predictor of high fear. A previous operative birth and having an unsupportive partner were predictors of high fear in multiparous women.ConclusionPsychosocial factors were associated with both high and severe fear levels. Screening for severe fear may detect women with pre-existing mental health problems that are exacerbated by fear of birth. Australian women with high childbirth fear levels (W-DEQ ≥66) should be identified and provided appropriate support.     

Re-examining pregnancy-related anxiety: A replication study

Background

Recognition of pregnancy-related anxiety as a distinct anxiety is supported by evidence differentiating it from general anxiety and depression. Adverse associations with pregnancy-related anxiety further support this distinction. An influential study by Huizink et al. (2004), demonstrated that anxiety and depression contribute little to the variance of pregnancy-related anxiety, yet this study has not been replicated. Further, addressing limitations of the original study will provide further clarity to the findings.

Negotiating who gives birth and the influence of fear of childbirth: Lesbians,bisexual women and transgender people in parenting relationships

BackgroundFear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied.AimThe aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC.MethodsSeventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis.ResultsFOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care.ConclusionsIt is important that healthcare staff address both partners’ prenatal expectancies and postnatal experiences.     

Women,Marital Status,and Symptoms of Depression in a Midlife National Sample

ABSTRACT

Previous studies of the correlates of depression among women have not generally been based on adequate midlife samples or precision in the specification of marital status categories. The present analysis is designed to address these deficiencies and is based on data from the Health and Retirement Survey-Wave 1 (i.e., respondents 51 to 61 years old). Results indicate that married women are less likely to report symptoms of depression than their unmarried counterparts. The mental health benefits of marriage are greater for men than for women. Moreover, other variables, such as marital satisfaction, self-rated health, and employment status are more powerful predictors of emotional well-being in midlife than marital status per se. The quality of marriage affects depressive symptoms more strongly for women than men.     

Using Rasch analysis to identify midwifery students’ learning about providing breastfeeding support

AimTo report on a study measuring midwifery students’ self-reported abilities in teaching and supervising breastfeeding mothers. Abilities were assessed at two time intervals, before and after completing a maternal and infant nutrition topic with simultaneous clinical opportunities to consolidate their skills.MethodA convenience sample of midwifery students in an Australian university completed a pre- and post-intervention survey to assess their self-rated ability to teach and supervise breastfeeding mothers. Rasch analysis was used to gain conjoint estimates of students’ self-reported abilities to teach and supervise breastfeeding mothers across 37 items with varying complexity of care needs. Rasch analysis was used to determine validity and reliability of the 37-item tool, to develop a hierarchical linear scale reflecting difficulty of breastfeeding supportive activities, and to determine student learning between the two time points.ResultsFrom 95 responses, 34 of the 37 items met the requirement for unidimensionality. Outcomes identified that midwifery students’ self-efficacy measures for breastfeeding support abilities can be reliably estimated. A hierarchical scale for learning these clinical skills has been generated to inform curricula development and learning processes. While there was an overall increase in the ease of difficulty of 21 items in the survey at time point two, eight items were identified as becoming more difficult.ConclusionThe findings of this study challenge midwifery educators to reconsider the educational activities provided for midwifery students’ that aim to develop the requisite skills to provide effective breastfeeding support, including the provision of specific clinical opportunities to learn from breastfeeding women.     

Self-regulation in older Thai women with self-reported knee osteoarthritis: A path analysis

Abstract

This study aimed at testing factors influencing coping behavior and health status among older women with knee osteoarthritis. A total of 274 participants completed questionnaires. Model testing revealed that self-efficacy was the most powerful predictor of coping behavior. Illness representation had a significant direct and indirect effect on health status and was a better predictor of health status than were the other variables. Understanding the complex relationships among study variables should help to tailor future interventions to better address the symptoms of osteoarthritis and to promote optimal health in older Thai women who report knee osteoarthritis.     

Social Support for Exercise by Experts in Older Women Post–Hip Fracture

ABSTRACT

Using the data of the Baltimore Hip Study 5 (a home-based exercise intervention), this study examined how social support for exercise by experts (SSE-E) affected the self-efficacy, outcome expectations, and exercise behavior among older women following a hip fracture. The total sample included 164 females aged 65 years (M = 81.0; SD = 6.9) who had surgical repair of a nonpathologic hip fracture. Model testing showed a direct relationship between SSE-E and outcome expectations for exercise. There was, however, no direct or indirect relationship between SSE-E and self-efficacy or exercise behavior. The positive effect of SSE-E on the outcome expectations for exercise in older women recovering from a hip fracture provides an opportunity for health care providers in improving physical activity in this population.     

Mindfulness-based programme on the psychological health of pregnant women

Problem

Preparation of psychological well-being is an important component of antenatal education for childbirth, but few courses focus on this component.

The relationship between birthing related factors and maternal breastfeeding confidence in China

ProblemThe relationship between birthing related factors and breastfeeding confidence remain unknown among Chinese mothers.BackgroundBreastfeeding confidence in the early postpartum period is an important predictor of breastfeeding duration. There are many postpartum and socio-demographic factors that have been linked to breastfeeding confidence. However, the relationship between birthing related factors and this confidence remain unknown.AimTo explore the relationship between birthing related factors and breastfeeding confidence among Chinese mothers.MethodsThis is a cross-sectional study of 450 mothers who were recruited after birth and before discharge from hospital. From November 2018 to March 2019, we collected data related to socio-demographics and obstetric characteristics, as well as the Chinese version of Breastfeeding Self-Efficacy Scale and the Chinese version of Labor Agentry Scale. Associations of birthing related factors with breastfeeding self-efficacy were investigated.ResultsThere was a significant correlation between perception of control during labor and breastfeeding confidence. Multiple linear regression showed that higher perception of control in labor scores were significantly associated with higher breastfeeding self-efficacy scores (B = 0.282, P = <0.001), and lower breastfeeding self-efficacy scores were associated with women living in an extended family (B = −12.622, P = <0.001), perceived of insufficient milk supply (B = −5.514, P = 0.038), mild fatigue (B = −8.021, P = 0.03), moderate fatigue (B = −12.955, P = 0.004).ConclusionThere is a significant relationship between perception of control during labor and maternal breastfeeding confidence in the early postpartum period. Strengthening perception of control during labor can improve breastfeeding self-efficacy. Providing professional and emotional support for women during the intrapartum period should be strengthened.     

Comparing the course of anxiety in women receiving their first or repeated caesarean section: A prospective cohort study

BackgroundAround 30% of births are through caesarean section and repetition rates for receiving a caesarean section are high.AimThe aim of the prospective study was to compare the course of anxiety in women undergoing their first caesarean section and women experiencing a repeated caesarean section.Participants304 women with an indication for an elective caesarean section took part. 155 received their first caesarean section and 149 received a repeated caesarean section.MethodsIn order to measure the course of anxiety on the day of the caesarean section subjective anxiety levels were measured and saliva samples for cortisol determination were taken at admission, during skin closure and two hours after the surgery. Blood pressure and heart rate were documented at skin incision and skin closure.ResultsWomen experiencing their first caesarean section displayed significantly higher anxiety levels compared to women with a repeated caesarean section. Scores of the STAI-State and visual analogue scale for anxiety differed significantly at admission (p = .006 and p < .001) and heart rate and alpha amylase levels were significantly higher at skin closure (p = .027 and p = .029).ConclusionThe results show that previous experience with a caesarean section has a soothing effect. The study aims to sensitize surgeons, anesthetists, nurses and midwives when treating women receiving a caesarean section and encourage them to incorporate soothing interventions, especially for women receiving their first caesarean section to reduce anxiety levels and consequently improve postoperative recovery and patients’ satisfaction.     

Yoga education program for older women diagnosed with sarcopenia: A multicity 10-year follow-up experiment

ABSTRACT

This article reports a multicity yoga education program (YEP) experiment aimed at improving gait speed, muscular strength, and functional performance in Asian and African older women diagnosed with sarcopenia. Posttest gait speed and muscle strength scale scores were higher, and the six functional performance tests scores were above average for women who were from Asian cities; middle class; currently married; living with spouse, children, or kin; with good self-rated health; who regularly attended the YEP lessons and regularly self-practiced. Instructors’ self-practice record was the strongest predictor of higher posttest scores. The YEP is an effective long-term prevention for sarcopenic older women.     

Trends and characteristics of women undergoing induction of labour in a tertiary hospital setting: A cross-sectional study

BackgroundIn many well-resourced countries, rising rates of intervention are being observed during pregnancy, labour and childbirth with induction of labour (IOL) fast becoming one of the most common. In Australia, the rate of induction of labour has increased by over 30% since 2007, and today one in three women have their labours induced. We do not however have a good understanding of the contribution of specific obstetric populations to this trend.MethodsWe examine the contribution of specific obstetric populations to induction of labour over a six-year period at one tertiary maternity service, using the Nippita classification system. Average Annual Percentage Changes (AAPC) were calculated along with 95% confidence intervals and P values set at 0.05.ResultsThe overall rate of induction of labour increased from 21.3% in 2012 to 30.9% in 2017, representing an Average Annual Percent Change of 8.1, P < 0.0001 (95% CI 7–9.6). The greatest AAPC was seen in group 5 (parous, no previous caesarean section, 39–40 weeks, single cephalic), followed by group 2 (nulliparous, 39–40 weeks, single cephalic) and 1 (nulliparous, 37–38 weeks, single cephalic).ConclusionsThe use of the Nippita classification system allowed for standardised comparison across timepoints, facilitating identification of the subpopulations driving changes in rates of induction of labour. Rates of induction of labour saw a year on year increase which in this maternity service, it is not being driven by post-dates pregnancies. Further work is required to understand the role of other potential contributors such as diabetes.