Women’s experiences of decision-making and attitudes in relation to induction of labour: A survey study

BackgroundRates of induction of labour have been increasing globally to up to one in three pregnancies in many high-income countries. Although guidelines around induction, and strength of the underlying evidence, vary considerably by indication, shared decision-making is increasingly recognised as key. The aim of this study was to identify women’s mode of birth preferences and experiences of shared decision-making for induction of labour.MethodAn antenatal survey of women booked for an induction at eight Sydney hospitals was conducted. A bespoke questionnaire was created assessing women’s demographics, indication for induction, pregnancy model of care, initial birth preferences, and their experience of the decision-making process.ResultsOf 189 survey respondents (58% nulliparous), major reported reasons for induction included prolonged pregnancy (38%), diabetes (25%), and suspected fetal growth restriction (8%). Most respondents (72%) had hoped to labour spontaneously. Major findings included 19% of women not feeling like they had a choice about induction of labour, 26% not feeling adequately informed (or uncertain if informed), 17% not being given alternatives, and 30% not receiving any written information on induction of labour. Qualitative responses highlight a desire of women to be more actively involved in decision-making.ConclusionA substantial minority of women did not feel adequately informed or prepared, and indicated they were not given alternatives to induction. Suggested improvements include for face-to-face discussions to be supplemented with written information, and for shared decision-making interventions, such as the introduction of decision aids and training, to be implemented and evaluated.     

The impact of outpatient priming for induction of labour on midwives’ work demand,work autonomy and satisfaction

BackgroundInduction of labour often begins with the application of a priming agent to soften the cervix, generally requiring women to stay in hospital overnight (inpatient priming). An alternative is outpatient priming by a midwife, where women are allowed to go home following priming. This approach has the potential to impact, either positively or negatively, on the midwives involved.QuestionTo what extent did the introduction of outpatient priming influence midwives’ work demands, work autonomy, stress and job satisfaction.MethodsA before–after study (with two separate cross-sectional samples) was conducted alongside a randomized controlled trial of outpatient versus inpatient priming, conducted at two metropolitan teaching hospitals in Australia. Midwives completed a questionnaire before the introduction of outpatient priming and again approximately two years later.Findings208 midwives participated (response rates-time 1:81% (87/108); time 2:78% (121/156)). A mixed model analysis test of pre-post intervention differences found no changes in work demand, work autonomy and satisfaction. At time 2, over 80% of midwives reported that the introduction of the practice had reduced or made no difference to their work stress and workload, and 93% reported that outpatient priming had increased or had no impact on their job satisfaction. Furthermore, 97% of respondents were of the opinion that the option of outpatient priming should continue to be offered.ConclusionResults suggest that outpatient priming for induction of labour is viable from a midwifery practice perspective, although more research is needed.     

Women’s experiences of antenatal transfer for threatened premature labour in NSW: A qualitative study

BackgroundEach year thousands of pregnant women experiencing threatened premature labour are transferred considerable distances across Australia to access higher level facilities but only a small proportion of these women go on to actually give birth to a premature baby. Women from regional areas are required to move away from their home, children and support networks because of a perceived risk of birthing in a centre without neonatal intensive care facilities.AimThis study examines the experience of women undergoing antenatal transfer for threatened premature labour in New South Wales and the Australian Capital Territory who do not give birth during their transfer admission.MethodsThirteen semi-structured in-depth interviews were held with women across five tertiary referral sites across New South Wales and the Australian Capital Territory, and analysed until saturation for themes.FindingsSeven urban and six rural women were interviewed. Women and their families were all negatively affected by antenatal transfer. Factors that helped enable a positive experience were; enhanced sense of safety in the tertiary unit, and individual qualities of staff. Factors that contributed to negative experiences were; inadequate and conflicting information, and no involvement or choice in the clinical decision-making process to move to another facility.ConclusionsAntenatal transfer is an extremely stressful experience for women and their families. The provision of high quality written and verbal information, and the inclusion of women's perception of risk in the clinical decision making process will improve the experience for women and their families in NSW and the ACT.     

Pregnant adolescent women’s perceptions of depression and psychiatric services in the United States

Problem

Adolescent mothers and their children are at high-risk for depression and the associated negative educational, social, health, and economic outcomes.

Women millennials’ perceptions of pension savings through the use of autoenrollment in the UK pension system

There has been concern about younger people, and women in particular, not saving enough for retirement and how to encourage further saving. Therefore, this study—partly funded by the Fawcett Society in association with Scottish Widows—explores female millennials’ attitudes and motivations toward pension saving and automatic enrollment through the use of 40 semistructured interviews and a focus group. The findings show that although the introduction of autoenrollment pensions is generally positively received, pensions knowledge is still limited, and this intensifies the risk of undersaving for retirement among millennial women, particularly given women’s diverse work histories.     

A comparison of college students’ perceptions of older and younger tattooed women

ABSTRACT

A randomly assigned sample of 376 college students responded to a survey involving a between-subjects 2 × 3 experiment designed to assess the impact of age (older versus younger) and tattoo status (i.e., no tattoo, feminine tattoo, or masculine tattoo) on three dependent measures: credibility, attractiveness, and promiscuity. Older and younger women are perceived differently depending on tattoo status. Not wearing a tattoo may lead to a more favorable perception of older women than wearing one, but wearing a feminine tattoo may engender a more favorable impression of older women than having a masculine tattoo. But not having a tattoo may not be as helpful for the perception of younger women as it is for older women. Also, while younger women may be rewarded for gender role transgression with respect to tattoo status, this is not so for older women.     

The effect of women’s participation in the labour market on the postponement of first childbirth: a comparison of Italy and Hungary

This paper analyses the effect of increasing female participation in the labour market on the transition to first childbirth. Regional perspectives are considered to help us understand how postponement behaviour is changing over time and at different paces in each region. The analysis is based on the first wave of the Generations and Gender Survey of Italy and Hungary. We use a multilevel event history random intercept model to examine the effect of individuals’ positions in the labour market on the transition to motherhood, controlling for differences in macrolevel factors related to regional backgrounds in the two countries. The regional data for Italy came from the Italian National Statistical Institute, and for Hungary from our imputation developed from the time series available at the national and the regional levels (Hungarian Central Statistical Office, KSH). The postponement of first childbirth is strongly linked to the increasing involvement of women in paid work, but with opposite effects in the two countries. Even if we control for changes in women’s levels of education over time and for shifts in women’s aspirations and levels of attainment in the labour market, we find that being employed remains a risk factor for the postponement of the first birth among Italian women, and a strong protective factor among Hungarian women. At the contextual level, the variables that take into account the regional socio-economic changes provides evidence of important effects on individual behaviour among Italian women, and of only minor effects among Hungarian women. All of the regional breakdowns in both Italy and Hungary show that the postponement of motherhood goes hand-in-hand with the acceptance of deep cultural and socio-economic changes.     

‘The calm before the storm’: A qualitative study of fathers’ experiences of early labour

BackgroundEarly labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour.MethodsOpportunity sample offathers (n = 12) in the UK who had been present during their partner’s labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis.ResultsFathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the ‘calm before the storm’ during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt ‘like a spare part’ during the later stages of labour.DiscussionThe study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing ‘nothing’. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value.     

Witnessing a body in decline: Men’s and women’s perceptions of an altered physical appearance

ABSTRACT

There has been a tendency within the literature to ignore how men and women who are very ill and at the end of life perceive and experience their visibly altered bodies. This article aims to provide new insights about this matter. A qualitative research approach was adopted. In-depth interviews were conducted with 10 hospice patients, 20 family members, and 20 members of hospice staff. Findings reveal that because of masculine and feminine norms, physical appearance is more a matter of concern to women than to men who are close to death. This contradicts theories that suggest that patients experience a disinvestment on their sense of masculinity and femininity alongside the process of bodily deterioration and decay prior impending potential death.     

A tale of two pregnancies: A Critical Interpretive Synthesis of women’s perceptions about delayed initiation of antenatal care

Background

Delayed access to antenatal care in high income countries is associated with poor maternal, fetal and neonatal outcomes. The aim was to synthesise the diverse body of evidence around women’s views of early antenatal care and barriers to attendance in such countries. Critical Interpretive Synthesis integrates the process of systematic review with the qualitative methods of meta-ethnography and grounded theory, with a focus on theory generation to inform policy, practice and future research.

Does antenatal education affect labour and birth? A structured review of the literature

ObjectiveTo undertake a structured review of the literature to determine the effect of antenatal education on labour and birth, particularly normal birth.MethodOvid Medline, CINAHL, Cochrane and Web of Knowledge databases were searched to identify research articles published in English from 2000 to 2012, using specified search terms in a variety of combinations. All articles included in this structured review were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).FindingsThe labour and birthing effects on women attending antenatal education may include less false labour admissions, more partner involvement, less anxiety but more labour interventions.ConclusionThis literature review has identified that antenatal education may have some positive effects on women's labour and birth including less false labour admissions, less anxiety and more partner involvement. There may also be some negative effects. Several studies found increased labour and birth interventions such as induction of labour and epidural use. There is contradictory evidence on the effect of antenatal education on mode of birth. More research is required to explore the impact of antenatal education on women's birthing outcomes.