Oral,systemic and socioeconomic factors associated with preterm birth

Background

The rates of preterm births have been increasing worldwide. Complications related to preterm births are associated with increased costs of care, and have a direct impact on the health system of the countries. Therefore, it is important to address factors associated with preterm birth in order to provide prevention strategies.

A retrospective comparison of water birth and conventional vaginal birth among women deemed to be low risk in a secondary level hospital in Australia

BackgroundWater birth involves the complete birth of the baby under warm water. There is a lack of consensus regarding the safety of water birth.AimThis study aimed to describe the maternal and neonatal outcomes associated with water birth among labouring women deemed at low risk for obstetric complications and compare these outcomes against women of similar risk who had a standard land birth.MethodA retrospective audit and comparison of women giving birth in water with a matched cohort who birthed on land at Bankstown hospital over a 10 year period (2000–2009).ResultsIn total 438 childbearing women were selected for this study (N = 219 in each arm). Primigravida women represented 42% of the study population. There was no significant difference in mean duration of both first and second stages of labour or postpartum blood loss between the two birth groups. There were no episiotomies performed in the water birth arm which was significantly different to the comparison group (N = 33, p < 0.001). There were more babies in the water birth group with an Apgar score of 7 or less at 1 min (compared to land births). However, at 5 min there was no difference in Apgar scores between the groups. Three of eight special care nursery admissions in the water birth group were related to feeding difficulties.ConclusionThis is the largest study on water birth in an Australian setting. Despite the limitations of a retrospective audit the findings make a contribution to the growing body of knowledge on water birth.     

Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital

BackgroundThere is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.AimThe aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.MethodsA retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.ResultsData for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = <0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.ConclusionStrategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population.     

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia

BackgroundEvidence suggests the closure of maternity units is associated with an increase in babies born before arrival (BBA).AimTo explore the association between the number of maternity units in Australia and Queensland by birthing numbers, BBA rate and geographic remoteness of the health district where the mother lives.MethodsA retrospective study utilised routinely collected perinatal data (1992–2011). Pearson correlation tested the relationship between BBA rate and number of maternity units. Linear regression examined this association over time.FindingsDuring 1992–2011, the absolute numbers (N = 22,814) of women having a BBA each year in Australia increased by 47% (N = 836–1233); and 206% (n = 140–429) in Queensland. This coincided with a 41% reduction in maternity units in Australia (N = 623–368 = 18 per year) and a 28% reduction in Queensland (n = 129–93). BBA rates increased significantly across Australia, r = 0.837, n = 20 years, p < 0.001 and Queensland, r = 0.917, n = 20 years, p < 0.001 and this was negatively correlated with the number of maternity units in Australia, r = −0.804, n = 19 years, p < 0.001 and Queensland, r = −0.906, n = 19 years, p < 0.001.ConclusionsThe closure of maternity units over a 20-year period across Australia and Queensland is significantly associated with increased BBA rates. The distribution is not limited to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes associated with BBA, it is time to revisit the closure of units.     

Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study

ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.DesignProspective cohort study.SettingTwo maternity hospitals in Ireland.PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38 °C), antibiotic treatment, first stage labour ≥10 h, second stage labour ≥2 h, blood loss (≥500 mls, ≥1000 mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1 min and 5 min, admission to neonatal intensive care unit, and infant feeding method.ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes.     

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.     

Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy

BackgroundIn March 2020, COVID-19 was declared to be a pandemic. While data suggests that COVID-19 is not associated with significant adverse health outcomes for pregnant women and newborns, the psychological impact on pregnant women is likely to be high.AimThe aim was to explore the psychological impact of the COVID-19 pandemic on Italian pregnant women, especially regarding concerns and birth expectations.MethodsA cross-sectional online survey of pregnant women in Italy was conducted. Responses were analysed for all women and segregated into two groups depending on previous experience of pregnancy loss. Analysis of open text responses examined expectations and concerns before and after the onset of the pandemic.FindingsTwo hundred pregnant women responded to the first wave of the survey. Most (n = 157, 78.5%) had other children and 100 (50.0%) had a previous history of perinatal loss. ‘Joy’ was the most prevalent emotion expressed before COVID-19 (126, 63.0% before vs 34, 17.0% after; p < 0.05); fear was the most prevalent after (15, 7.5% before vs 98, 49.0% after; p < 0.05). Positive constructs were prevalent before COVID-19, while negative ones were dominant after (p < 0.05). Across the country, women were concerned about COVID-19 and a history of psychological disorders was significantly associated with higher concerns (p < 0.05). A previous pregnancy loss did not influence women’s concerns.ConclusionsWomen’s expectations and concerns regarding childbirth changed significantly as a result of the COVID-19 pandemic in Italy. Women with a history of psychological disorders need particular attention as they seem to experience higher levels of concern.     

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions

AimTo determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth.MethodsThis single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or “show”. The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann–Whitney and Chi–square tests. The level of statistical significance was set as p < 0.05.FindingThere were significant differences between the intervention and control groups in the number of caesarian section (CS) (p < 0.001). Two groups had a statistically significant difference in amniotomy (p = 0.003), augmentation by oxytocin (p < 0.001), number of vaginal examinations (p < 0.001) and fundal pressure (p < 0.001).ConclusionsUsing a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.     

Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial

ObjectiveTo evaluate the effect of mother–infant immediate skin-to-skin contact on primiparous mother's breastfeeding self-efficacy.Study designA randomised control trial.SettingsThe study was conducted in Omolbanin obstetrics hospital (large tertiary hospital), Mashhad, Iran.Participants114 18–35 year-old primiparous, Iranian, healthy and full term mothers who anticipated normal vaginal delivery and intended to breastfeed their babies.InterventionSkin-to-skin contact immediately after birth and then controlling breastfeeding self-efficacy at 28 days postpartum.Main outcome measureMaternal breastfeeding self-efficacy at 28 days postpartum and success in first breastfeeding and mean time of first breastfeeding initiation.ResultsA total of 92 mother–infant dyads (47 dyads in skin-to-skin care skin-to-skin contact group and 45 dyads in routine care group) were monitored and analysed. In skin-to-skin contact group, breastfeeding self-efficacy was 53.42 ± 8.57 SD as compared to 49.85 ± 5.50 SD in routine care group which is significantly higher in skin-to-skin contact group (p = 0.0003).Successful breastfeeding initiation rate was 56.6% in skin-to-skin contact group as compared to 35.6% in routine care group (p = 0.02).Time to initiate first feed was 21.98 ± 9.10 SD min in SSC group vs. 66.55 ± 20.76 min in routine care group (p < 0.001).ConclusionMother–infant immediate skin-to-skin contact is an easy and available method of enhancing maternal breastfeeding self-efficacy. High breastfeeding self-efficacy increases exclusive breastfeeding duration.     

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.     

Variables related to maternal satisfaction with intrapartum care in Northern Italy

BackgroundThe experience of labour and birth is complex, multidimensional and subjective and has the potential to affect the women and their families physically and emotionally. However, there is a lack of research around maternal satisfaction in Italy.AimTo evaluate mothers’ satisfaction with their childbirth experience in relation to socio-demographic characteristics, obstetric history and intrapartum care variables.MethodsA cross-sectional study involving 277 women who had given birth in a low risk maternity unit in Northern Italy was undertaken. Satisfaction with birth was measured using the Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R). The scale comprises three Sub-Scales: quality of care provided, personal attributes of women and stress experienced during childbirth.FindingsNo socio-demographic variables were related to maternal satisfaction. Multiparous women had a higher satisfaction score (p = 0.020; CI:0.23;2.75). Antenatal class attendance was negatively associated with maternal satisfaction (p = 0.038; CI:−2.58; −0.07). Intrapartum variables that significantly reduced maternal satisfaction were: epidural usage (p = 0.000; CI:−4.66; −2.07), active phase >12 h (p = 0.000; CI:−6.01; −2.63), oxytocin administration (p = 0.000; CI:−5.08; −2.29) and vacuum assisted birth (p = 0.001; CI:−6.50; −1.58). Women with an intact perineum were more likely to be satisfied (p = 0.008; CI:−4.60; −0.69).DiscussionIn accordance with other research, we showed that intrapartum interventions are negatively associated with maternal outcomes and therefore also with maternal satisfaction with birth. The sub-scale that measured Quality of Care provided scored higher than the other two Sub-Scales.ConclusionFurther studies on maternal satisfaction in Italy should be conducted, using the I-BSS-R with the aim to compare outcomes and understand what matters to women during childbirth.     

Does it happen and why? Lived and shared experiences of mistreatment and respectful care during childbirth among maternal health providers in a tertiary hospital in Nigeria

IntroductionGlobally, mistreatment during childbirth remains a powerful deterrent to skilled birth utilization.AimWe determined the perpetrated and witnessed experiences of mistreatment and Respectful Maternity Care (RMC) among maternal health providers in a tertiary hospital in Nigeria.MethodsA cross-sectional study was conducted among 156 maternal health providers in a tertiary hospital in Nigeria. Information was collected using semi-structured, self-administered questionnaires, and 3 focus group discussions. Quantitative and qualitative data analyses were performed using SPSS version 20 and thematic analysis respectively.FindingsMost respondents were males (64.1%) and doctors (74.4%) with mean age of 31.97 ± 6.82. Two-fifths (39.1%) and 73.1% of the respondents had ever meted out or witnessed disrespectful and abusive care to women during childbirth respectively. Verbal abuse and denial of companionship in labour were major mistreatments reported qualitatively and quantitatively. About a third of the respondents mistreated women 1–2 times in a week. Younger respondents had 64% lower odds of reporting mistreatment during childbirth (AOR = 0.36, 95% CI = 0.14−0.96). The most and least frequently practiced RMC element were provision of consented care (62.8%) and allowing birth position of choice respectively (3.8%). Poor hospital patronage and reputation were the perceived consequences of mistreatment during childbirth.ConclusionWitnessed rather than self-perpetrated mistreatment during childbirth was more reported in addition to poor RMC practices Self-perpetrated mistreatment during childbirth was less reported among younger providers. We recommend intensification of provider capacity building on RMC with special focus on older practitioners and the provision of supportive work environments that encourage respectful maternal care practices.     

The comparison of the interpersonal action component of woman-centred care reported by healthy pregnant women in different sized practices in the Netherlands: A cross-sectional study

BackgroundThe number of interventions is lower, and the level of satisfaction is higher among women who receive midwife-led primary care from one or two midwives, compared to more midwives. This suggests that midwives in small-sized practices practice more women-centred. This has yet to be explored.ObjectiveTo examine pregnant women’s perceptions, of the interpersonal action component of woman-centred care by primary care midwives, working in different sized practices.MethodsA cross-sectional study using the Client Centred Care Questionnaire (CCCQ), administered during the third trimester of pregnancy among Dutch women receiving midwife-led primary care from midwives organised in small-sized practices (1−2 midwives), medium-sized (3−4 midwives) and large-sized practices (≥5 midwives). A Welch ANOVA with post hoc Bonferroni correction was performed to examine the differences.Results553 completed questionnaires were received from 91 small-sized practices/104 women, 98 medium-sized practices/258 women and 65 large-sized practices/191 women. The overall sum scores varied between 57–72 on a minimum/maximum scoring range of 15–75. Women reported significantly higher woman-centred care scores of midwives in small-sized practices (score 70.7) compared with midwives in medium-sized practices (score 63.6) (p < .001) and large-sized practices (score 57.9) (p < .001), showing a large effect (d .88; d 1.56). Women reported statistically significant higher woman-centred care scores of midwives in medium-sized practices compared with large-sized practices (p < .001), showing a medium effect (d .69).ConclusionThere is a significant variance in woman-centred care based on women’s perceptions of woman-midwife interactions in primary care midwifery, with highest scores reported by women receiving care from a maximum of two midwives. Although the CCCQ scores of all practices are relatively high, the significant differences in favour of small-sized practices may contribute to moving woman-centred care practice from ‘good’ to ‘excellent’ practice.     

Opportunities for enhancing pregnancy planning and preconception health behaviours of Australian women

Problem and backgroundThe preconception period provides a significant opportunity to engage women in healthy behaviour change for improved maternal and child health outcomes. However, there is limited research exploring women’s pregnancy planning in Australia.AimThis study investigated associations between pregnancy planning, socio-demographics and preconception health behaviours in Australian women.MethodsA retrospective cross-sectional survey of pregnant women ≥18-years-of-age recruited through a Victorian public maternity service and a national private health insurer.ResultsOverall 317 women (30 ± 4.7 years) participated (public: n = 225, private: n = 92). Planned pregnancies were reported by 74% of women and were independently associated with marital status (AOR = 5.71 95% CI 1.92–17.00, p = 0.002); having ≤2 children (AOR = 3.75 95% CI 1.28–11.05, p = 0.016); and having private health insurance (AOR = 2.51 95% CI 1.08–5.81, p = 0.03). Overall, women reported preconception: any folic-acid supplementation (59%), up-to-date cervical screening (68%), weight management attempts (75%), accessing information from health professionals (57%) and immunisation reviews (47%). Pregnancy planners were more likely to use folic-acid (AOR = 17.13 95% CI 7.67–38.26, p < 0.001), review immunisations (AOR = 2.09 95% CI 1.07–4.10, p = 0.03) and access information (AOR = 3.24 95% CI 1.75–6.00, p < 0.001) compared to non-planners. Women <25-years-of-age were less likely to access information (AOR = 0.38 95% CI 0.16–0.89, p = 0.03) and take folic-acid (AOR = 0.23 95% CI 0.09–0.59, p = 0.002) and were more likely to smoke 3-months preconception (AOR = 6.68 95% CI 1.24–36.12, p = 0.03).ConclusionsWomen with planned and unplanned pregnancies reported variable preconception health behaviour uptake and limited healthcare engagement. Opportunities exist to improve awareness and healthcare engagement for optimising preconception health and pregnancy planning benefits including collaborative health promotion. Population-based and targeted approaches reaching pregnancy planners and non-planners are required.     

Maternity Care Plans: A retrospective review of a process aiming to support women who decline standard care

BackgroundAll competent adults have the right to refuse medical treatment. When pregnant women do so, ethical and medico-legal concerns arise and women may face difficulties accessing care. Policies guiding the provision of maternity care in these circumstances are rare and unstudied. One tertiary hospital in Australia has a process for clinicians to plan non-standard maternity care via a Maternity Care Plan (MCP).AimTo review processes and outcomes associated with MCPs from the first three and a half years of the policy's implementation.MethodsRetrospective cohort study comprising chart audit, review of demographic data and clinical outcomes, and content analysis of MCPs.FindingsMCPs (n = 52) were most commonly created when women declined recommended caesareans, preferring vaginal birth after two caesareans (VBAC2, n = 23; 44.2%) or vaginal breech birth (n = 7, 13.5%) or when women declined continuous intrapartum monitoring for vaginal birth after one caesarean (n = 8, 15.4%). Intrapartum care deviated from MCPs in 50% of cases, due to new or worsening clinical indications or changed maternal preferences. Clinical outcomes were reassuring. Most VBAC2 or VBAC>2 (69%) and vaginal breech births (96.3%) were attempted without MCPs, but women with MCPs appeared more likely to birth vaginally (VBAC2 success rate 66.7% with MCP, 17.5% without; vaginal breech birth success rate, 50% with MCP, 32.5% without).ConclusionsMCPs enabled clinicians to provide care outside of hospital policies but were utilised for a narrow range of situations, with significant variation in their application. Further research is needed to understand the experiences of women and clinicians.     

What do midwives fear?

BackgroundThere is evidence that a significant number of women are fearful about birth but less is known about the fears of maternity health providers and how their fear may impact on the women they care for.AimThe aim of this study was to determine the top fears midwives in Australia and New Zealand hold when it comes to caring for childbearing women.MethodFrom 2009 to 2011, 17 workshops were held in Australia and New Zealand supporting over 700 midwives develop skills to keep birth normal. During the workshop midwives were asked to write their top fear on a piece of paper and return it to the presenters. Similar concepts were grouped together to form 8 major categories.FindingsIn total 739 fears were reported and these were death of a baby (n = 177), missing something that causes harm (n = 176), obstetric emergencies (n = 114), maternal death (n = 83), being watched (n = 68), being the cause of a negative birth experience (n = 52), dealing with the unknown (n = 36) and losing passion and confidence around normal birth (n = 32). Student midwives were more concerned about knowing what to do, while homebirth midwives were mostly concerned with being blamed if something went wrong.ConclusionThere was consistency between the 17 groups of midwives regarding top fears held. Supporting midwives with workshops such as dealing with grief and loss and managing fear could help reduce their anxiety. Obstetric emergency skills workshops may help midwives feel more confident, especially those dealing with shoulder dystocia and PPH as they were most commonly recorded.     

Disclosure of sensitive material at routine antenatal psychosocial assessment: The role of psychosocial risk and mode of assessment

ProblemWhile routine psychosocial assessment is acceptable to most pregnant women, some women will not fully disclose psychosocial concerns to their clinician.AimsTo assess the impact of psychosocial risk, current symptoms and mode of assessment on women’s honesty of disclosure at psychosocial assessment.MethodsLogistic regression was used to examine associations between disclosure and a range of psychosocial characteristics in women who were ‘always honest’ and ‘not always honest’. Mixed ANOVAs were used to test the influence of mode of assessment and honesty on scores on a repeated measure of psychosocial risk.Findings10.8% (N = 193 of 1788) of women did not fully disclose at psychosocial assessment. Non-disclosure was associated with a mental health history (aOR = 1.78, 95%CI: 1.18–2.67, p < 0.01) and lack of social and partner support (aOR = 1.74, 95%CI: 1.16–2.62, p < 0.05; aOR = 2.08, 95%CI: 1.11–3.90, p < 0.05, respectively). Those reporting not always being honest at face to face assessment showed a greater increase in psychosocial risk score when the assessment was repeated online via self-report, compared to women who were always honest.DiscussionA history of mental health issues and lack of social and partner support are associated with reduced disclosure at face to face assessment. Online self-report assessment may promote greater disclosure, however this should always be conducted in the context of clinician feedback.ConclusionGreater psychosocial vulnerability is associated with a lower likelihood of full disclosure. Preliminary findings relating to mode of assessment warrant further exploration within a clinical context.