The role of women's attitudinal profiles in satisfaction with the quality of their antenatal and intrapartum care

Women's experiences of being assisted by two midwives during the active second stage of labour: Secondary outcomes from the Oneplus trial

BACKGROUND

'Collegial Midwifery Assistance' (CMA) is a clinical practice aiming to reduce severe perineal trauma (SPT) during childbirth. This practice involves two midwives being present during the active second stage of labour rather than one, which is the case in standard care. The effectiveness of CMA was evaluated in the Oneplus trial and a 30% reduction in SPT was shown.

AIM

The aim was to investigate the experience of women who received the CMA intervention in the trial and to explore factors influencing their experiences.

METHODS

A cohort study using data from the Oneplus trial and a one-month postpartum follow-up questionnaire. Descriptive statistics, univariable and multivariable logistic regression analyses were performed.

RESULTS

A total of 1050 women who received the CMA intervention responded to the questionnaire. Of these, 35.8% reported that they strongly agreed with feeling safe during the second stage of labour and 42.6% were inclined to have an additional midwife present at a subsequent birth. The intervention was favourably received by women who experienced fear of birth, who were non-native Swedish speakers, and had lower educational attainment. Furthermore, women were more positive towards CMA the longer the intervention lasted.

CONCLUSIONS

The results of this study suggest that the CMA intervention is accepted well by women and can be safely implemented into standard care. The duration of the CMA intervention was an important factor that influenced women's experiences and should be used to guide future practice.

A critical review: developing a birth integrity framework for epidemiological studies through meta-ethnography

Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.

Information Needs During Pregnancy and Its Associated Factors in Afghan Pregnant Migrant Women in Iran

Background: Access to pregnancy-related information is an important requirement for all pregnant women, especially women at risk, such as immigrants. Regarding this, the present study was conducted to determine the information needs during pregnancy and its associated factors in the Afghan pregnant women. Methods: This cross-sectional study was conducted on 280 Afghan pregnant women who received care at the prenatal clinics of selected health care centers in the southeast of Tehran in 2018. The study population was selected using the continuous sampling method. The sampling was performed through the continuous sampling method from all the Afghan pregnant women who received care at the prenatal health centers of the southeast of Tehran. Results: Among the information needs during pregnancy, the fetal (83.34 ± 20.65) and smoking (62.61 ± 28.88) domains had the highest and lowest mean scores by percentage, respectively. The information needs during pregnancy showed a statistically significant relationship with age, women’s education level, husband’s education level, duration of living in Iran, place of residence, insurance status, number of children, place of the previous delivery, and routine prenatal care. Based on the multiple regression model, only the place of birth and place of residence accounted for 19% of information needs during pregnancy. Conclusion: As the findings indicated, the prenatal care–related education should address the domains that are unknown for Afghan women. Furthermore, in this education, the demographic and reproductive characteristics of the recipients should be taken into account to improve the pregnancy outcome among this population.

Testing the birth attitude profile scale in a Swedish sample of women with fear of birth

OBJECTIVE

The aim of this study was to explore the "Birth Attitude Profile Scale (BAPS)" in a selected sample of women with fear of birth. Another aim was to develop profiles of women according to their birth attitudes and levels of childbirth fear in relation to background characteristics.

METHODS

A secondary analysis of data collected in two different samples of women with fear of birth. Data were collected by a questionnaire in gestational week 36 and background data from mid-pregnancy. A principal component analysis and a cluster analysis were performed of the combined sample of 195 women.

RESULTS

The principal component analysis revealed four domains of the BAPS: "personal impact, birth as a natural event, freedom of choice and safety concerns". When adding the fear of birth scale, two clusters were identified: one with strong attitudes and lower fear, labeled "self-determiners"; and one with no strong attitudes but high levels of fear, labeled "fearful." Women in the "Fearful" cluster more often reported previous and current mental health problems, which were the main difference between the clusters.

CONCLUSION

The BAPS instrument seems to be useful in identifying birth attitudes in women with fear of birth and could be a basis for discussions and birth planning during pregnancy. Mental health problems were the main difference in cluster membership; therefore, it is important to ask women with fear of childbirth about physical, mental and social aspects of health. In addition, a qualitative approach using techniques such as focus groups or interviews is needed to explore how women come to form their attitudes and beliefs about birth.

Patient experience studies in the circumpolar region: a scoping review

OBJECTIVES

Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients' interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region.

DESIGN

In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken.

DATA SOURCES

Seven electronic databases were queried: MEDLINE, Embase, Scopus, 'Global Health 1910 to 2019 Week 11', CINAHL, PsycINFO and SveMed+.

ELIGIBILITY CRITERIA

Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients' perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome.

DATA EXTRACTION AND SYNTHESIS

Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes.

RESULTS

Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change.

CONCLUSIONS

The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods.

Psychometric testing of the support and control in birth scale

Background

The Support and Control in Birth (SCIB) scale primarily measures the perceived support and control of expectant mothers during childbirth, thereby obtaining an understanding of their birth experiences. The advantages of this scale are its good reliability and validity and that it consolidates birth support and control. However, a Chinese version of the scale has yet to be developed. Therefore, this study sought to evaluate the validity and reliability of a Chinese version of the Support and Control in Birth Scale (C-SCIB).

Methods

A total of 228 postpartum women participated in this study. The C-SCIB scale was developed through a translation and back translation, followed by an evaluation of its content validity by a group of experts. Cronbach’s α internal consistency and test-retest reliability were used to test the reliability of the scale. In addition, criterion-related validity (predictive validity and concurrent validity) and construct validity were used to test the validity of the scale.

Results

The C-SCIB scale showed good results in terms of the item-level and scale-level content validity indices. The Cronbach’s α internal consistency was 0.81, and its test-retest reliability was 0.96. The confirmatory factor analysis results showed the overall goodness-of-fit was parsimony fit indices. The predictive validity analysis showed a significant positive correlation between the C-SCIB scale and the Questionnaire Measuring Attitudes About Labor and Delivery (r = 0.31, p < 0.01). Furthermore, the concurrent validity analysis showed a significant and moderate correlation between the C-SCIB and the Bryanton Adaptation of the Nursing Support in Labor Questionnaire (r = 0.49, p < 0.01) as well as the Labor Agentry Scale (r = 0.51, p < 0.01).

Conclusion

The C-SCIB scale was proven to have good reliability and validity, and thus can be used to measure the degree of support and the locus of control perceived by expectant women during labor.

Women's satisfaction with maternity care during preterm birth

BACKGROUND

Women's satisfaction with maternity care is strongly influenced by their sociodemographic characteristics, values, and attitudes. The arrival of a preterm baby is often a traumatic time, with unique factors involved. The Spanish Preterm Birth Experience and Satisfaction Scale (P-BESS) is a robust instrument capable of assessing women's satisfaction during preterm birth. The purpose of this study was to assess women's satisfaction with maternity care during labor and birth with preterm babies in a Spanish-speaking population.

METHODS

This is a cross-sectional study. Participants were 182 women who gave birth within 37 weeks' gestation. Factors associated with satisfaction were studied through univariate and bivariate analyses and through multiple linear regression using the backward elimination method.

RESULTS

Women reported high satisfaction with maternity care overall (average score of 84 out of 95). Women with a university education were generally less satisfied. Women were more satisfied if they were pregnant for the first time. Women who reported a previous premature birth or neonatal death were more satisfied, and women who had prior miscarriages were less satisfied compared with women without these experiences.

CONCLUSIONS

The analysis confirmed that the majority of women surveyed were very satisfied with their childbirth experience. The Spanish P-BESS can be a useful way of prioritizing intervention measures, focusing on those aspects lowest scored by women, such as "information and explanations" and "confidence in staff," to improve maternity services for families experiencing preterm birth.

Perinatal women's satisfaction with nurses caring behaviours in teaching hospitals in China

BACKGROUND

Adequate caring behaviours provided by nurses can increase patients' satisfaction of care. Yet few researchers have examined women's satisfaction in nurses' caring behaviours in China and then published the study in English.

AIM

The aim of this study was to identify the level of women's satisfaction with nurses' caring behaviours during the antenatal, childbirth and postnatal periods.

METHODS

A descriptive, cross-sectional study was performed using a sample of 422 postpartum women of two teaching hospitals in Wuhan, China. A structured questionnaire on socio-demographic information was completed, and a satisfaction scale of 60 items concerning nurses' caring behaviours was measured.

RESULTS

The findings showed that participants reported a good satisfaction score for nurses' caring behaviours during all three periods. Behaviours on the 'Monitor' subscale obtained the highest score (a mean score of 4.46 for the antenatal period, 4.64 for the childbirth period and 4.31 for the postnatal period). The subscale with the second highest score was 'Human respect' (4.53, 4.27 and 4.56, respectively), while the subscale with the lowest score was 'Trust' (3.78 and 3.98). The statistical significances of the demographics of the women were shown concerning their perceived satisfaction of five subscales of caring behaviours.

CONCLUSION

The study revealed no statistically significant differences in the perceived satisfaction in nurses' caring behaviours between the antenatal, childbirth and postnatal periods. However, nursing administration development projects that focus on caring are still needed. Additionally, more studies that reflect Watson's theory of human caring on the maternity population should be conducted with a larger sample size.

Women's labour experiences and quality of care in relation to a prolonged latent phase of labour

AIM

To describe primiparous and multiparous women's labour experiences and their perception of quality of intrapartum care, in relation to background characteristics and length of latent phase of labour prior to admittance to labour ward.

DESIGN

A cross-sectional study.

SETTING

A middle-sized hospital in a rural county in western part of Sweden.

PARTICIPANTS

Primiparous and multiparous women, both low-risk and risk, with a spontaneous onset of labour after gestational week 37+0 were included. In total, n = 1193 women were invited, and n = 757 responded the questionnaire, n = 342 primiparous and n = 415 multiparous women.

METHODS

The Intrapartal-specific Quality from Patient Perspective (QPP-I), with responses on perceived reality and subjective importance, was used for data collection. QPP-I covers ten factors of quality of care. Background characteristics, length of latent phase of labour, global items about labour experience and items regarding feelings during labour and birth were included. Data were analysed with descriptive and analytic statistics.

FINDINGS

All factors in QPP-I were rated higher for subjective importance than perceived reality, except for information about selfcare, for both primi- and multiparous women. Labour experience, perceived reality of quality of care, and feelings were related to length of the latent phase of labour. Primiparous women with a prolonged latent phase (>18 h) had significantly lower scores regarding six out of ten QPP-I factors (PR); Information procedures, Information self-care, Commitment (midwives), Commitment (enrolled nurses), Midwives present, and Partner/ significant others. They scored lower on Experience birth as normal and Safe during labour and birth. The felt less proud and felt more ignored by professionals. Multiparous women with a prolonged latent phase of labour scored significantly lower on one QPP-I factor, Commitment (midwives). They also scored lower on Control over the situation and felt less safe during labour and birth.

KEY CONCLUSION

Women's perception of quality of intrapartum care, the birth experience and feelings are related to length of the latent phase of labour. Women perceive quality of intrapartum care as being lower than its subjective importance.

IMPLICATIONS FOR PRACTICE

A prolonged latent phase of labour can be regarded as a risk factor for a more negative birthing experience.

Women's Perceived Quality of Care and Self-Reported Empowerment With CenteringPregnancy Versus Individual Prenatal Care

OBJECTIVE

To compare perceived quality of prenatal care and pregnancy-related self-reported empowerment between women participating in CenteringPregnancy versus those receiving individual prenatal care provided by certified nurse-midwives in the same clinic.

DESIGN

Nonexperimental, longitudinal, descriptive feasibility study of two independent groups.

SETTING/LOCAL PROBLEM

A prenatal clinic in northern Texas where all care is provided by certified nurse-midwives.

PARTICIPANTS

The study assessed 51 women receiving self-selected prenatal care in the form of individual prenatal care (n = 37) or CenteringPregnancy (n = 14).

INTERVENTION/MEASUREMENTS

Outcomes analyzed included perceived quality of prenatal care and pregnancy-related self-reported empowerment.

RESULTS

The results showed no statistical significance between the individual prenatal care and CenteringPregnancy groups with regard to perceived quality of prenatal care or pregnancy-related self-reported empowerment.

CONCLUSION

CenteringPregnancy has the capability to provide women with quality of care equal to that achieved through traditional prenatal care. Despite the lack of statistically significant findings, this study exposes several areas of interest and provides guidance for future studies evaluating prenatal care.

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

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

The pregnancy experience: a mixed methods analysis of women's understanding of the antenatal journey

BACKGROUND

Positive contact with antenatal care and its providers improves positive outcomes for women and their babies. This involves the accrual and use of knowledge accumulated through education, experiential learning and other fora and is reliant on a positive experience.

AIMS

Women's knowledge of antenatal and postnatal care was examined, in addition to the positive and negative feelings and experiences they associate with it.

METHODS

Employing a mixed methodology, a self-administered questionnaire was distributed to women attending antenatal clinics. It consisted of open and closed questions examining women's experiences of antenatal care and knowledge of the intrapartum and postnatal journey. Following this, individual semi-structured interviews were conducted with eight postnatal women gaining further in-depth insight into their peripartum experiences.

RESULTS

Respondents to the questionnaire had varied opinions and beliefs about the purpose of antenatal care and prenatal screening policies, with the majority of their knowledge obtained from non-medical sources. The knowledge of labour and its complications was significantly better in multiparous women. However, in some postnatal scenarios, both cohorts lacked knowledge. In the qualitative study, women described positive feelings with their experience of antenatal care, with women expressing variations in the amount of knowledge they wanted to receive.

CONCLUSIONS

This research demonstrates the varied experiences of women attending our services, highlighting both the positive and negative aspects of care. Topics of poor knowledge are highlighted, particularly in primiparous women and regarding the postnatal period. Using this information, women can be provided with an optimised, personalised experience in our maternity services.

A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth - A study protocol

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

Is quality of care a key predictor of perinatal health care utilization and patient satisfaction in Malawi?

BACKGROUND

The Malawi government encourages early antenatal care, delivery in health facilities, and timely postnatal care. Efforts to sustain or increase current levels of perinatal service utilization may not achieve desired gains if the quality of care provided is neglected. This study examined predictors of perinatal service utilization and patients' satisfaction with these services with a focus on quality of care.

METHODS

We used baseline, two-stage cluster sampling household survey data collected between November and December, 2012 before implementation of CARE's Community Score Card© intervention in Ntcheu district, Malawi. Women with a birth during the last year (N = 1301) were asked about seeking: 1) family planning, 2) antenatal, 3) delivery, and 4) postnatal care; the quality of care received; and their overall satisfaction with the care received. Specific quality of care items were assessed for each type of service, and up to five such items per type of service were used in analyses. Separate logistic regression models were fitted to examine predictors of family planning, antenatal, delivery, and postnatal service utilization and of complete satisfaction with each of these services; all models were adjusted for women's socio-demographic characteristics, perceptions of the closest facility to their homes, service use indicators, and quality of care items.

RESULTS

We found higher levels of perinatal service use than previously documented in Malawi (baseline antenatal care 99.4%; skilled birth attendance 97.3%; postnatal care 77.5%; current family planning use 52.8%). Almost 73% of quality of perinatal care items assessed were favorably reported by > 90% of women. Women reported high overall satisfaction (≥85%) with all types of services examined, higher for antenatal and postnatal care than for family planning and delivery care. We found significant associations between perceived and actual quality of care and both women's use and satisfaction with the perinatal health services received.

CONCLUSIONS

Quality of care is a key predictor of perinatal health service utilization and complete patient satisfaction with such services in Malawi. The current heightened attention toward perinatal health services and outcomes should be coupled with efforts to improve the actual quality of care offered to women in this country.

Explorando las emociones de la mujer en la atención perinatal. Un estudio cualitativo

Objetivo: explorar las emociones que emergen en la mujer durante el embarazo, parto y el puerperio a lo largo del itinerario asistencial de atención primaria y hospitalaria. Método: estudio cualitativo basado en la Teoría Fundamentada. Se realizaron dos grupos de discusión a profesionales: obstetras, matronas y enfermeras. Igualmente, se desarrollaron entrevistas en profundidad a mujeres en el puerperio. Resultados: las emociones de la mujer en la atención perinatal aparece como categoría central. A partir de ésta, las emociones negativas emergen por la interacción de cinco metacategorías: a) Miedo: dolor al parto y desajuste de expectativas, b) Ansiedad e incertidumbre: enfrentándose a la amenaza del riesgo y la desinformación, c) Vergüenza: comprometiendo la privacidad, d) Ira y Desamparo: asimetría en la estructura relacional, e) Soledad: discontinuidad en la atención asistencial. Las emociones positivas surge de la metacategoría: f) Tranquilidad y confianza: construyendo una interacción clínica simétrica y humanizada. Conclusiones: se constata una variabilidad emocional debido a la coexistencia de los modelos tecnocrático y biopsicosocial. Este proyecta humanidad en los cuidados perinatales, frente a un modelo biomédico marcado por una estructura relacional paternalista y asistencia fragmentada; ambos serán determinantes en la emergencia de emociones en la atención perinatal.

The Turkish version of perceived support and control in birth scale

OBJECTIVE

This is a methodological study carried out to evaluate the validity and reliability of the Turkish version of the Support and Control in Birth Scale (SCIB).

METHODS

This study included 339 post-partum women. The validity of the Turkish version of the scale was assessed in terms of content and construct validity. Reliability was evaluated using the internal consistency coefficient, the test-retest correlation coefficient and the item correlation between the subscales.

RESULTS

The internal consistency coefficient of the scale was 0.84 (p < 0.01). There were significant correlations between sub-scales (rho = 0.122, 0.129, 0.263, p < 0.05), and the test-retest correlation coefficient of the scale was also significant (rho = 0.86, α = 0.000). As in the original scale, a three-factor structure was examined, which explained 42.85% of the total variance. The model was verified by a confirmatory factor analysis.

CONCLUSION

The Turkish version of the SCIB is a reliable and valid instrument for measuring the perceived support and control during birth among Turkish women.

Gaining insight into how women conceptualize satisfaction: Western Australian women's perception of their maternity care experiences

Background

The concept of maternal satisfaction is challenging, as women’s and clinicians’ expectations and experiences can differ. Our aim was to investigate women’s experiences of maternity care in an urban tertiary obstetric setting, to gain insight into conceptualization of satisfaction across the childbirth continuum.

Methods

This mixed method study was conducted at a public maternity hospital in Western Australia. A questionnaire was sent to 733 women two weeks post birth, which included an invitation for an audio-recorded, telephone interview. Frequency distributions and univariate comparisons were employed for quantitative data. Thematic analysis of interview transcripts was undertaken to extract common themes.

Results

A total of 54 % (399 of 733) returned the questionnaire. Quantitative results indicated that women were less likely to feel: involved if they did not have a spontaneous vaginal birth (P = 0.020); supported by a midwife if they had a caesarean (P = <0.001); or supported by an obstetrician if they had a spontaneous vaginal birth (P = <0.001).

Qualitative findings emerged from 63 interviews which highlighted the influence that organization of care, resources and facilities had on women’s satisfaction. These paradigms unfolded as three broad themes constructed by four sub-themes, each illustrating a dichotomy of experiences. The first theme ‘how care was provided’ encompassed: familiar faces versus a different one every time and the best place to be as opposed to so disappointed. The second theme ‘attributes of staff’ included: above and beyond versus caring without caring and in good hands as opposed to handled incorrectly. The third theme ‘engaged in care’ incorporated: explained everything versus did not know why and had a choice as opposed to did not listen to my needs.

Conclusions

Quantitative analysis confirmed that the majority of women surveyed were satisfied. Mode of birth influenced women’s perception of being involved with their birth. Being able to explore the diversity of women’s experiences in relation to satisfaction with their maternity care in an urban, tertiary obstetric setting has offered greater insight into what women value: a sensitive, respectful, shared relationship with competent clinicians who recognise and strive to provide woman focused care across the childbirth continuum.

Expectations and satisfaction with antenatal care among pregnant women with a focus on vulnerable groups: a descriptive study in Ghent

Background

Previous studies demonstrate that people’s satisfaction with healthcare influences their further use of that healthcare system. Satisfied patients are more likely to take part in the decision making process and to complete treatment. One of the important determinants of satisfaction is the fulfillment of expectations. This study aims to analyse both expectations and satisfaction with antenatal care among pregnant women, with a particular focus on vulnerable groups.

Methods

A quantitative descriptive study was conducted in 155 women seeking antenatal care at the University Hospital of Ghent (Belgium), of whom 139 completed the questionnaire. The statistical program SPSS-21 was used for data analysis.

Results

Women had high expectations relating to continuity of care and women-centered care, while expectations regarding availability of other services and complete care were low. We observed significantly lower expectations among women without higher education, with low income, younger than 26 years and women who reported intimate partner violence. General satisfaction with antenatal care was high. Women were satisfied with their relationship with the healthcare worker, however ; they evaluated the information received during the consultation and the organizational aspects of antenatal care as less satisfactory.

Conclusions

In order to improve satisfaction with antenatal care, organizational aspects of antenatal care (e.g. reducing waiting times and increasing accessibility) need to be improved. In addition, women would appreciate a better provision of information during consultation. More research is needed for an in-depth understanding of the determinants of satisfaction and the relationship with low socio economic status (SES).

Electronic supplementary material

The online version of this article (doi:10.1186/s12905-015-0266-2) contains supplementary material, which is available to authorized users.

Identifying women who are afraid of giving birth: A comparison of the fear of birth scale with the WDEQ-A in a large Australian cohort

BACKGROUND

The WDEQ-A is the most widely used measure of childbirth fear in pregnant women; however there is increasing discussion in the literature that simpler, more culturally transferrable tools may offer a better solution to identifying fearful women in clinical practice.

AIM

To compare the two item Fear of Birth Scale (FOBS) with the 33 item WDEQ-A in a large cohort of Australian pregnant women.

METHOD

Self-report questionnaires during second trimester including Wijma Delivery Expectancy Questionnaire (WDEQ-A) and Fear of Birth Scale (FOBS). Correlation of FOBS and WDEQ-A was tested using Spearman's correlation coefficients. Receiver operating characteristic (ROC) curve assessed the sensitivity and specificity of possible cut-points on the FOBS against WDEQ-A cut-point of ≥85. Sensitivity, specificity, positive and negative predictive values were determined. Fearful and non-fearful women as classified by both instruments were compared for differences in demographic, psycho-social and obstetric characteristics.

RESULTS

1410 women participated. The correlation between the instruments was strong (Spearman's Rho = 0.66, p < 0.001). The area under the ROC was 0.89 indicating high sensitivity with a FOBS cut-point of 54. Sensitivity was 89%, specificity 79% and Youden index 0.68. Positive predictive value was 85% and negative predictive value 79%. Both instruments identified high fear as significantly associated with first time mothers, previous emergency caesarean and women with self-reported anxiety and/or depression. Additionally FOBS identified a significant association between fearful women and preference for caesarean.

CONCLUSION

This study supports the use of the FOBS in clinical practice to identify childbirth fear in pregnant women.

The influence of detailed maternal ethnicity on cesarean delivery: findings from the U.S. birth certificate in the State of Massachusetts

BACKGROUND

Our objective was to examine the likelihood of primary cesarean delivery for women at low risk for the procedure in Massachusetts.

METHODS

Birth certificate data for all births from 1996 to 2010 that were nulliparous, term, singleton, and vertex (NTSV; N = 427,393) were used to conduct logistic regression models to assess the likelihood of a cesarean delivery for each of the 31 ethnic groups relative to self-identified "American" mothers. The results were compared with broad classifications of race/ethnicity more commonly employed in research.

RESULTS

While 23.3 percent of American women had primary cesarean deliveries, cesarean delivery rates varied from 12.9 percent for Cambodian to 32.4 percent for Nigerian women. Women from 21 of 30 ethnic groups had higher odds of a primary cesarean (range of adjusted odds ratios [AORs] 1.09-1.77), while only Chinese, Cambodian, and Japanese women had lower odds (range of AORs 0.66-0.92), compared with self-identified "Americans." Using broad race/ethnicity categories, Non-Hispanic black, Hispanic, and "Other" women had higher odds of cesarean delivery relative to Non-Hispanic white women (range of AORs 1.12-1.47), while there were no differences for Asian or Pacific Islander women.

CONCLUSIONS

Detailed maternal ethnicity explains the variation in NTSV cesarean delivery rates better than broad race/ethnicity categories. Different patterns of cesarean delivery between ethnic groups suggest cultural specificity related to birth culture.

Motivating patients

Patients who seek advice and treatment for periodontal conditions often find challenges in the personal involvement required for successful care. This paper reviews methods of advising and motivating patients to adhere to oral hygiene regimens and understand the necessity for long-term management of the condition.